Lenalidomide-induced Pseudogout and Crowned Dens Syndrome

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Key Words: lenalidomide, pseudogout, crowned dens syndrome, myelomaAn 84-year-old male diagnosed with IgA myeloma was treated with lenalidomide.The disease was managed adequately; however, after 11 months, he experienced high-grade fever, swelling and pain in his right elbow, and severe posterior neck pain.A cloudy joint fluid was identified (Figure 1A), and the patient was diagnosed with pseudogout.Moreover, he was diagnosed with crowned dens syndrome based on cervical spine findings of computed tomography (Figure 1B).Discontinuation of lenalidomide and administration of nonsteroidal antiinflammatory drugs reduced these symptoms.Nine months after the lenalidomide cessation, myeloma worsened, and readministration of lenalidomide led to generalized arthralgia and severe swelling of the left ankle joint; lenalidomide-induced arthritis occurrence was clinically confirmed.In Japan, 24, 8, and 1 cases of mild arthralgia, arthritis, and joint swelling, respectively, have been reported.Notably, some joint symptoms can be associated with lenalidomide-associated pseudogout.

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