Secondary Hypertrophic Osteoarthropathy

dok_zlo — 07.04.2024

A 55-year-old woman with a 29-pack-year history of smoking presented with a 1.5-year history of pain in her fingers, wrists, hips, knees, and ankles. On physical examination, clubbing and slight thickening of the skin of the fingers and toes were noted (Panel A, right foot). There was mild tenderness on palpation of all her affected joints but no erythema or swelling. A cardiopulmonary examination was normal. Radiographs of the forearms, hands, femurs, tibia, and feet showed symmetric periostitis of the tubular bones (Panel B, right foot, arrows; Panel C, right ulna and radius, arrows). The combination of painful arthropathy, periostitis, and clubbing prompted consideration of hypertrophic osteoarthropathy. Hypertrophic osteoarthropathy is a syndrome that is characterized by thickening of the skin and expansion of the bone of the distal arms and legs and is often associated with lung cancer. A chest radiograph showed a large mass on the left side (Panel D), which was further characterized as an anterior mediastinal mass on subsequent computed tomography. A biopsy of the mass revealed poorly differentiated non–small-cell carcinoma. A final diagnosis of secondary hypertrophic osteoarthropathy due to non–small-cell lung cancer was made. Systemic chemotherapy was initiated, but the patient died of pneumonia 2 months later.
Authors: Margarida Lucas Rocha, M.D. https://orcid.org/0000-0003-3665-8210, and Vitor Silvestre-Teixeira, M.D.Author Info & Affiliations
Published April 3, 2024
N Engl J Med 2024;390:1218
DOI: 10.1056/NEJMicm2309119
VOL. 390 NO. 13

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