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Rheumatoid arthritis (RA) may be associated with an increased risk of haematological malignancy, perhaps as a result of RA itself or of its treatment. We describe the unusual case of a patient with longstanding RA who developed both lymphoproliferative and myeloproliferative malignancy without exposure to disease modifying drugs.
A 64 year old woman, wheelchair dependent with spina bifidar related spastic paraparesis, had seropositive RA never treated with disease modifying drugs. In 1993, she developed Philadelphia chromosome positive, chronic myelogenous leukaemia (CML), treated with busulfan, initially 2 mg daily and subsequently on alternate days. Within 3 months, her total white cell count normalised and busulfan was discontinued. No further treatment was required for the CML.
Over subsequent years she required increasing support, including inpatient care, for immobility due to spina bifida, …