Dysphagia and Bone Marrow Failure: A Rare Neoplastic Mimic

A 54-year-old male with a history of multiple autoimmune arthritides was admitted following a 3-week history of progressive dysphagia with odynophagia to solids and liquids, with significant weight loss, night sweats, and exertional dyspnoea. Oesophagogastroduodenoscopy revealed an obstructing oesophageal stricture. Blood tests showed neutropaenia and high levels of inflammatory markers, suggestive of primary oesophageal malignancy. Oesophageal and bone marrow biopsies demonstrated inflammatory change not suggestive of malignancy. PET showed highly active nodules in the left lung and sigmoid colon, but the oesophagus was clear. Following a clinical rheumatology review, a differential diagnosis of inflammatory lesions, most likely secondary to systemic rheumatoid, was considered. The patient responded well to high-dose intravenous steroid therapy. Subsequent outpatient interval high-resolution CT demonstrated complete resolution of the lung nodule. He was maintained on oral prednisolone and methotrexate, having no further symptoms of dysphagia or neutropenia. A literature search revealed no published reports or case studies outlining a similar history to the reported patient: rheumatoid arthritis presenting to hospital as potential oesophageal malignancy.