Hypertrophic pulmonary osteoarthropathy: an unusual presentation

Abstract

Objectives Hypertrophic pulmonary osteoarthropathy (HPOA) is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. HPOA without clubbing of the digits is considered an incomplete form of HPOA and has been rarely reported. We are presenting here a case of HPOA without clubbing in a patient with lung cancer. Methods A 52-year-old female active smoker presented with a complaint of multiple joint pains with associated morning stiffness, swelling and weight loss for 3 months. On examination, the patient had tenderness to palpation over the anterior shin, but no obvious clubbing was noted. X-rays of the lower extremities revealed periosteal thickening compatible with HPOA. Results A bone scan showed increased uptake along the periosteum and cortex of the long bones. In view of her smoking history and weight loss, a chest X-ray was done that revealed an upper lung mass. A diagnosis of lung carcinoma was made on biopsy. Conclusion Our case demonstrates that the unusual finding of HPOA in the absence of clubbing is a rare entity and can often be missed. Once diagnosed, a prompt search of other associated conditions should be conducted.

Chronic Joint Pain in a Young Adult With Cystic Fibrosis

“…Some patients may describe no joint or bony pain and may have only severe digital clubbing, which is the most common manifestation on physical examination. In others, pain and swelling of one or more joints may be the predominant symptoms and warrant broader diagnostic considerations [13]. The distribution and acuity of joint involvement as well as other predisposing conditions or family history can narrow the differential diagnosis.…”