[Surgical Treatment for Lung Cancer Associated with Hypertrophic Pulmonary Osteoarthropathy].

Hypertrophic pulmonary osteoarthropathy( HPO) is a rare paraneoplastic manifestation of lung cancer that causes joint pain, joint swelling, and limited range of motion. Two surgical cases of lung cancer with HPO are presented. Case1:A 43-year-old female was referred to our department with a diagnosis of cStage ⅡB left hilar lung cancer. She had difficulty in walking due to arthralgia caused by HPO. Left pneumonectomy was performed and the arthralgia disappeared on the first postoperative day. The patient is being well after surgery without relapse of joint symptoms. Case2:The patient was a 65-year-old male with cStage ⅡA right lung cancer. The symptoms of HPO appeared after he was found to have lung cancer. After right upper lobectomy, the arthralgia disappeared on the first postoperative day. Currently, he is receiving adjuvant chemotherapy, without relapse of joint symptoms.

A 49-Year-Old Man With Cough and Hand, Wrist, and Knee Pain.

CASE PRESENTATION: A 49-year-old man was sent by his primary care physician to the rheumatology clinic with complaints of several months of bilateral lower extremity swelling. The swelling migrated from both ankles up to his knees. Presenting symptoms consisted of bilateral knee pain as well as bilateral wrist and hand pain with swelling. Pulmonary symptoms consisted of a nagging productive cough of several months. He also complained of significant weight loss: 50 pounds over 12 months. He was a never smoker. The examination was notable for bilateral knee effusions. Radiographs of his wrists, hands, and knee were obtained, along with a chest radiograph. He was then referred to a pulmonologist for further workup.

Hypertrophic Osteoarthropathy in a Patient With Primary Hepatic Angiosarcoma.

Primary hepatic angiosarcoma was diagnosed in a 59-year-old woman who presented an arthralgia of limbs and dry cough for 6 weeks. Physical examination revealed digital clubbing. A Tc-MDP bone scintigraphy showed diffusely increased uptake along the cortical margins of long bones, suggesting hypertrophic osteoarthropathy.

Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature.

BACKGROUND: Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by abnormal proliferation of skin and periosteal tissues of the extremities. It can be a rare hereditary disease (pachydermoperiostosis) or can be secondary to various diseases, though mostly lung malignancies. Here, we report an unusual clinical presentation of HOA. CASE PRESENTATION: A 77-year-old man presented with fever, diarrhea, and an oligoarthritis involving the left knee and the ankles. Since left knee synovial fluid aspiration revealed an aseptic synovitis and Clostridium Difficile toxin was detectable in stool samples, a reactive arthritis secondary to a Clostridium Difficile induced colitis was initially suspected. However, the presence of a worsened digital clubbing and the lack of a good clinical response to steroid therapy led us to perform a radionuclide bone scanning, which revealed HOA. This turned out to be associated with a lepidic predominant lung adenocarcinoma, which was clinically and radiologically difficult to distinguish from a relapse of pneumonia. CONCLUSION: Consistent with the literature, HOA tends to have a variable clinical presentation, mimicking that of various rheumatic diseases. This clinical case shows that HOA can present as a presumptive acute reactive arthritis, and it highlights the importance of patient's follow-up in the differential diagnosis of inflammatory arthritis, especially when a worsened digital clubbing is present.