Hypertrophic pulmonary osteoarthropathy: an unusual presentation

Hypertrophic Pulmonary Osteoarthropathy - An Overlooked Clue of Lung Cancer

Hypertrophic osteoarthropathy (HOA) is a syndrome that presents with classic findings of digital clubbing, arthralgia, and periostosis of tubular bones. When HOA is associated with pulmonary pathologies such as lung malignancies, it is referred to as hypertrophic pulmonary osteoarthropathy (HPOA). We present a case of an elderly woman who presents with significant pain in both hands and was eventually diagnosed with lung malignancy. This case is of interest to hospital-based internists to ensure timely diagnosis of HPOA so a brief overview of the presentation, laboratory findings, and treatment of HPOA is discussed.

Chronic Joint Pain in a Young Adult With Cystic Fibrosis

A 25-year-old male with end-stage cystic fibrosis (CF) with genotype F508del/F508del presented to the clinic complaining of bilateral knee and ankle pain. He had severe lung disease (forced expiratory volume 1 {FEV1} 19% of predicted), chronic colonization with achromobacter, malnutrition, and CF-related diabetes. On physical examination, he was found to have bilateral knee swelling as well as pain on flexion and extension of the wrists and ankles without erythema or warmth. He was empirically started on prednisone and tramadol; however, at a three-month follow-up visit, he remained symptomatic. He was sent for a whole-body bone scan, which was consistent with hypertrophic pulmonary osteoarthropathy (HPOA). He was started on highly effective modulator therapy with elexacaftor/tezacaftor/ivacaftor and symptoms spontaneously resolved without further intervention.