Seronegative rheumatoid arthritis and non Hodgkin's lymphoma occurred 30 years after paraffin injection into the penis

A case report of a male patient with human adjuvant disease

Abstract

Human adjuvant disease is a connective tissue disease similar to disorder occurring after cosmetic surgery by the use of foreign substance. No male patient with this disease have been reported until now. We recently observed a 49-year-old man developed seronegative rheumatoid arthritis and non-Hodgkin's lymphoma 30 years after the injection of foreign substance into the penis.
The patient visited our hospital because of difficulty of neck movement and bilateral omalgia. He also had polyarthritis in the bilateral carpal and knee joints with bone erosions. The synovial fluid from a inflamed knee joint failed to form sufficient mucin clotting. It did not contained malignant cells. By histological examination, foreign body granulomas were noted not only in the injected site but also in the inguinal lymphnodes. The foreign substance was chemically identified as paraffin. The removal of the substance produced no significant improvement in his clinical course, but by the administration of 10mg daily prednisolone improved his arthralgia dramatically. Four months after discharge, he noted a small nodule in the left cervical region which was diagnosed as non-Hodgkin's lymphoma, diffuse large cell type by histological examination. He was treated with ⁶⁰Co irradiation and chemotherapy. The tumor regressed and complete remission was induced after 2 months.
Several clinical features of this patient were compatible with human adjuvant disease reported in female patients. It is also interesting that he subsequently developed malignant lymphoma.