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Association between systemic sclerosis, palmar fasciitis with polyarthritis, Raynaud's phenomenon and erythromelalgia with underlying malignancy. Reumatologia 2022; 60:275-280. [PMID: 36186832 PMCID: PMC9494792 DOI: 10.5114/reum.2022.119044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
The symptoms of a rheumatic disease may also be a sign of a proliferative process. These include conditions that present with skin and vascular changes such as systemic sclerosis and Raynaud's phenomenon with peripheral ischaemia and ulceration. Furthermore, the less common conditions - erythromelalgia or palmar fasciitis with polyarthritis may also accompany cancer. In this article, we discuss the association of diffuse systemic sclerosis with anorectal tumor, palmar fasciitis and polyarthritis with ovarian cancer, erythromelalgia with underlying ovarian malignancy and Raynaud's phenomenon and digital ischemia associated with renal carcinoma. Based on the literature review on this topic we highlighted the importance of recognizing paraneoplastic syndromes at an early stage. This is a crucial point in the adequate management of a patient. Many of the paraneoplastic symptoms of rheumatic and other described conditions may regress with the management of the underlying malignancy.
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2
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Abstract
Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic rheumatic disease with characteristic features. We herein report a 77-year-old man with lung adenocarcinoma and contralateral pulmonary metastasis receiving chemotherapy who presented with progressive symmetrical flexion contractures associated with palmar fascial thickening and arthritis of both hands and shoulders. He was diagnosed with PFPAS as paraneoplastic manifestations. Salazosulfapyridine was not effective, but 15 mg/day of oral prednisolone improved his symptoms. Physicians should consider PFPAS and rule out malignancy in patients with arthritis in the extremities and flexion contractures associated with palmar fascial thickening.
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Affiliation(s)
- Hisatoshi Okumura
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Hidetaka Ishino
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Daisuke Yokoi
- Division of General Internal Medicine, North Medical Center Kyoto Prefectural University of Medicine, Japan
| | - Masami Matsumura
- Division of General Internal Medicine, Jichi Medical University, Japan
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3
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Silvério-António M, Parlato F, Martins P, Khmelinskii N, Braz S, Fonseca JE, Polido-Pereira J. Gastric Adenocarcinoma Presenting as a Rheumatoid Factor and Anti-cyclic Citrullinated Protein Antibody-Positive Polyarthritis: A Case Report and Review of Literature. Front Med (Lausanne) 2021; 8:627004. [PMID: 34109188 PMCID: PMC8180584 DOI: 10.3389/fmed.2021.627004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
A 64-year-old male presented with a 6-month history of symmetric polyarthritis involving proximal interphalangeal joints and metacarpophalangeal joints of the hands, wrists, and ankles. Associated symptoms included vomiting, progressive fatigue, and weight loss. Laboratory results showed microcytic anemia, leukocytosis, thrombocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACPA) antibody positivity. Joints radiographs were normal, without erosions. Upper endoscopy and gastric endoscopic ultrasonography showed a gastric adenocarcinoma with lymphatic involvement. Intraoperatively, peritoneal carcinomatosis was documented, and the patient started palliative chemotherapy. A paraneoplastic seropositive arthritis was assumed, and treatment with low-dose prednisolone and hydroxychloroquine was started. Arthritis remission was achieved and sustained up to 18 months of follow-up, although gastric cancer progression was documented. We describe a unique phenotype of paraneoplastic arthritis (PA) presenting as a seropositive (RF and ACPA positivity) rheumatoid arthritis (RA) with a good response to both low dose corticosteroids and hydroxychloroquine therapy. We also review the literature of PA, mostly the RA-like pattern, and the association between PA and ACPA positivity. This case highlights the importance of considering underlying cancer in elderly male patients, presenting with polyarthritis and systemic symptoms, even in those with ACPA-positive RA-like arthritis.
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Affiliation(s)
- Manuel Silvério-António
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Federica Parlato
- Medicina 2 Department, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - Patrícia Martins
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Sandra Braz
- Medicina 2 Department, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim Polido-Pereira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
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4
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Hematological malignancies mimicking rheumatic syndromes: case series and review of the literature. Rheumatol Int 2018; 38:1743-1749. [DOI: 10.1007/s00296-018-4107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
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5
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Abstract
A variety of conditions mimicking rheumatologic syndromes may be associated with an underlying malignancy. Therefore, distinguishing these syndromes from more common, nonparaneoplastic rheumatologic conditions can be perplexing. Some autoimmune conditions and the medications used for their management can be associated with increased future risk of malignancy. Some cancers can directly involve the musculoskeletal structures, whereas others present with systemic manifestations at sites away from the tumor and its metastases. Better awareness and timely recognition of these associations may lead to earlier cancer detection and, it is hoped, better long-term survival.
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Affiliation(s)
- Mandana Hashefi
- Division of Rheumatology, George Washington University, 2300, M Street, Northwest, Suite: 3-307, Washington, DC 20037, USA.
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7
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Migrating Polyarthritis as a Feature of Occult Malignancy: 2 Case Reports and a Review of the Literature. Case Rep Oncol Med 2015; 2015:934039. [PMID: 26558124 PMCID: PMC4629013 DOI: 10.1155/2015/934039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022] Open
Abstract
Malignant disease may be associated with a wide variety of musculoskeletal syndromes. Rarely the musculoskeletal system can be indirectly affected by paraneoplastic phenomena, such as carcinomatous polyarthritis (CP). The differential diagnosis for CP is broad and is often a diagnosis of exclusion. CP often presents similarly to other forms of inflammatory arthritis, and a detailed history and physical examination can often distinguish CP from other more common causes of polyarticular arthritis. However serological tests such as rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibody positivity, while rare, can be misleading. Clinical awareness and suspicion are paramount in achieving an accurate diagnosis and early detection of an occult neoplasm is critical for prompt management and therapy. We report two cases presenting with this unique clinical phenotype associated with paraneoplastic polyarthropathy and review the literature.
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Kennedy N, Chapman P. Paraneoplastic fasciitis and polyarthritis syndrome as a manifestation of breast cancer recurrence in a BRCA1 gene-positive patient. Int J Rheum Dis 2015; 20:1876-1878. [PMID: 26443230 DOI: 10.1111/1756-185x.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicholas Kennedy
- Department of Rheumatology and Immunology, Christchurch Hospital, Christchurch, New Zealand
| | - Peter Chapman
- Department of Rheumatology and Immunology, Christchurch Hospital, Christchurch, New Zealand
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9
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Lazarev I, Shelef I, Refaely Y, Ariad S, Ifergane G. Two Paraneoplastic Autoimmune Syndromes: Limbic Encephalitis and Palmar Fasciitis in a Patient with Small Cell Lung Cancer. Rare Tumors 2015; 7:5721. [PMID: 26500723 PMCID: PMC4600985 DOI: 10.4081/rt.2015.5721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 12/03/2022] Open
Abstract
Small cell lung cancer (SCLC) is characterized by a relatively high rate of autoimmune phenomena. Paraneoplastic limbic encephalitis (PLE) is an autoimmune syndrome in which a non-neural tumor containing an antigen normally present in the nervous system precipitates an antibody attack on neural tissues. Patients with PLE usually present with rapidly progressive short-term memory deficits, confusion or even dementia. Palmar fasciitis and polyarthritis syndrome (PFPAS) is another autoimmune syndrome characterized by rheumatologic manifestations, especially involving the palms of the hands. We report a case of a 59-year old woman who presented with worsening neurological symptoms of two-week duration, and later coma. The combined clinical, serological, and imaging studies suggested a diagnosis of PLE. A chest computed tomographic scan showed a 1.2 cm-diameter mass in the upper lobe of the left lung that was surgically removed and showed SCLC. Following surgery, neurological symptoms rapidly improved, allowing the patient to receive adjuvant chemotherapy. While in remission for both SCLC and PLE, the patient developed pain, soft-tissue swelling, and stiffness in both palms, suggesting the diagnosis of PFPAS. Five months following the diagnosis of palmar fasciitis, SCLC relapsed with mediastinal and cervical lymphadenopathy. This case report underlines the continuous interaction of SCLC with the immune system, expressed by coexistence of two rare paraneoplastic diseases, PLE, and PFPAS, in a patient with SCLC. While symptoms related to PLE preceded the initial diagnosis of SCLC, other symptoms related to PFPAS preceded relapse.
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Affiliation(s)
- Irina Lazarev
- Departments of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheba, Israel
| | - Ilan Shelef
- Departments of Imaging, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheba, Israel
| | - Yael Refaely
- Departments of Thoracic Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheba, Israel
| | - Samuel Ariad
- Departments of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheba, Israel
| | - Gal Ifergane
- Departments of Neurology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheba, Israel
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10
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Fukui S, Fujiwara S, Kobayashi S, Kamei S, Takizawa Y, Setoguchi K, Uno M, Funata N. Fallopian Tube Cancer with Palmar Fibromatosis or Fasciitis without Polyarthritis. Intern Med 2015; 54:2409-14. [PMID: 26370871 DOI: 10.2169/internalmedicine.54.4551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 64-year-old Japanese woman had rapidly progressing bilateral palmar contracture associated with severe pain on both palms over the previous 8 weeks, without a history of arthritis in any joints. We suspected palmar fibromatosis or fasciitis without polyarthritis. Because palmar fibromatosis is known to be associated with cancer, we performed cancer screening and the patient was subsequently diagnosed with fallopian tube cancer. This is the first case report of palmar fibromatosis or fasciitis without polyarthritis associated with fallopian tube cancer. The characteristic rapid progression of palmar contracture is a key finding that suggests the potential existence of a malignancy.
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Affiliation(s)
- Shoichi Fukui
- Department of Rheumatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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11
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Manger B, Schett G. Palmar fasciitis and polyarthritis syndrome—Systematic literature review of 100 cases. Semin Arthritis Rheum 2014; 44:105-11. [DOI: 10.1016/j.semarthrit.2014.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 02/14/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
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Abstract
Palmar fasciitis and polyarthritis syndrome is a rare paraneoplastic condition that may portend a diagnosis of malignancy. We describe the case of a 73-year-old man who presented with progressive palmar swelling, erythema, pain, and contractures of both hands, This presentation and associated weight loss eventually led to the diagnosis of metastatic pancreatic adenocarcinoma. This case highlights the often delayed, but important diagnosis of this unusual paraneoplastic phenomenon which can mimic arthropathy, Dupuytren contracture, and scleroderma. Our case is also the first documentation of the extensive inflammatory magnetic resonance imaging changes in palmar fasciitis and polyarthritis syndrome, which affects all tissue planes including the synovium and explains its confusing clinical manifestations.
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14
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Nadal R, McMahan ZH, Antonarakis ES. Paraneoplastic palmar fasciitis and polyarthritis syndrome in a patient with advanced prostate cancer. Clin Genitourin Cancer 2013; 11:e15-23. [PMID: 23820064 DOI: 10.1016/j.clgc.2013.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/09/2013] [Accepted: 05/14/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Rosa Nadal
- Department of Oncology, Johns Hopkins University, Baltimore, MD.
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15
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Three new cases of palmar fasciitis with polyarthritis including a patient with atypical mutilating osteolysis. Joint Bone Spine 2013; 80:217-20. [DOI: 10.1016/j.jbspin.2012.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2012] [Indexed: 11/17/2022]
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17
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McGIVERN U, McALEESE J. Palmar fasciitis: a para-neoplastic phenomenon indicating recurrence of non small cell lung cancer - case report and review of the literature. Int J Rheum Dis 2011; 15:e8-9. [DOI: 10.1111/j.1756-185x.2011.01689.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Abstract
Taken together, the wide range of rheumatic and musculoskeletal conditions that can appear in association with cancer emphasizes that rheumatic disease is a major component of the spectrum of paraneoplastic manifestations. Although the pathogenetic mechanisms by which neoplasia causes these manifestations are only partially understood in select cases, it appears that many result from immune-mediated effects stimulated by tumor antigens of endocrine factors produced by tumors. The broad overlap in signs and symptoms of occult malignancy and systemic rheumatic disease, as well as the occurrence of distinct localized and systemic musculoskeletal and rheumatic syndromes in the presence of cancer, emphasizes the importance of considering and investigating the possibility of occult malignancy in the evaluation of patients with these symptoms. This is particularly important in older patients, those with atypical rheumatic disease, and those who do not respond appropriately to conventional immunosuppressive therapy.
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Affiliation(s)
- Judith F Ashouri
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, 400 Parnassus, San Francisco, CA, USA
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19
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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20
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Clarke LL, Kennedy CT, Hollingworth P. Palmar fasciitis and polyarthritis syndrome associated with transitional cell carcinoma of the bladder. J Am Acad Dermatol 2011; 64:1159-63. [DOI: 10.1016/j.jaad.2009.11.680] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 11/25/2009] [Accepted: 11/29/2009] [Indexed: 02/07/2023]
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21
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Bolibar EP, Raya JS, Simeon CP, Montesinos L, Jou N, Cuxart A. Palmar fascitis and polyarthritis as a paraneoplastic syndrome associated with ovarian carcinoma: a case report. BMJ Case Rep 2009; 2009:bcr05.2009.1899. [PMID: 22190980 DOI: 10.1136/bcr.05.2009.1899] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report concerns a 49-year-old woman whose physical examination was remarkable for symmetrical swollen hands, fingers and palmar fascial thickening with erythema. The fingers showed flexion contractures. Examination also revealed markedly limited bilateral shoulder and limited knee flexion.The patient's symptoms were treated with rehabilitation. The immunological laboratory investigations were normal. A technetium scan showed a slightly increased uptake in both shoulders, wrists, hips, knees and ankles. CT revealed a pelvic solid mass next to the uterus. After the patient underwent a total hysterectomy and anexectomy, the polyarthritis showed a gradual improvement but the contractures in the hands persisted.Palmar fasciitis and polyarthritis syndrome (PFPAS) is an uncommon rheumatic disorder consisting of pain, swelling, stiffness, progressive flexion contractures of both hands and thickening of palmar fascia, with erythrosis. It was first described as a paraneoplastic phenomenon with ovarian carcinoma in 1982.The characteristic hand deformities of PFPA should alert the clinician to search for an underlying malignant disease.
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Affiliation(s)
- Esther Pages Bolibar
- Vall d'Hebron Hospital, Physical Medicine and Rehabilitation, Avda Vall d'Hebron 115, Barcelona, Barcelona, 08035, Spain
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Margolis AM, Emmerman AB, Rascon M, Chaudhry SI. Nonconstrictive epicarditis mimicking a cardiac mass in a 71-year-old Caucasian man: a case report and review of the literature. J Med Case Rep 2009; 3:2. [PMID: 19126192 PMCID: PMC2639604 DOI: 10.1186/1752-1947-3-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 01/06/2009] [Indexed: 11/23/2022] Open
Abstract
Introduction Isolated cases of epicarditis are rare. Thus far, all have occurred with constrictive physiology as most cases involve both parietal and visceral pericardium. We report the first case of asymptomatic epicarditis that involved only the visceral pericardium presenting without constrictive physiology. Case presentation A 71-year-old male with a history of atrial fibrillation, coronary artery disease, pericardial effusion, type-2 diabetes and hypothyroidism presented with 5 weeks of fatigue and 1 day of dizziness. Physical examination was significant for pallor and tachycardia. Laboratory analysis revealed a hemoglobin count of 7.2 g/dl and iron deficiency anemia. The patient was transfused and evaluated by endoscopic ultrasound. A polypoid mass in the gastric cardia was found and later diagnosed as gastric adenocarcinoma (staged as T1N0M0). The pericardial effusion was evaluated with transthoracic echocardiography which showed a 2.0 × 2.7 cm mass associated with the right atrium. Transesophageal echocardiography confirmed the mass but did not reveal constrictive physiology. Whole-body contrast computed tomography failed to demonstrate metastatic disease. Biopsy of the cardiac mass revealed epicarditis without parietal pericardium involvement. Partial gastrectomy was performed to remove the gastric adenocarcinoma. Conclusion This is the first reported case of asymptomatic epicarditis. Our case was especially unusual because the epicarditis presented as an incidental cardiac mass. The clinical picture was complicated due to the concomitant presence of gastric adenocarcinoma and chronic pericardial effusion. This case demonstrates that epicarditis should be considered in the differential diagnosis of cardiac masses.
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Preda VA, Frederiksen P, Kossard S. Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome. Australas J Dermatol 2009; 50:198-201. [DOI: 10.1111/j.1440-0960.2009.00538.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ono H, Suzuki N, Mizuno H, Tateyama M, Aoki M, Itoyama Y. [Elevated serum aldolase activity in a patient of non-eosinophilic myofasciitis and synovitis with perifascicular atrophy]. Rinsho Shinkeigaku 2009; 49:119-122. [PMID: 19348178 DOI: 10.5692/clinicalneurol.49.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 35-year-old man suffered from myalgia and joint pain on walking for 5 months. Physical and neurological examinations revealed dermal sclerosis, skin swelling, redness of forearms, Raynaud's phenomenon, joint pain, myalgia and muscle weakness. Eosinophilia was not found and serum creatine kinase activity was normal, while aldolase was markedly elevated. Abnormal signals suggesting synovitis and myofasciitis were found on MRI images. Biopsy of the fascia of quadriceps femoris showed perivascular mononuclear cell infiltration. A muscle biopsy showed mononuclear cell infiltration mainly in the perimysium extending to the endmysium. Eosinophilic cells were not found, Perifascicular atrophy was observed. Corticosteroid therapy improved clinical symptoms and serum aldolase level. We diagnosed him as non-eosinophilic myofasciitis and synovitis with perifascicular atrophy. The serum aldolase activity is usuful for diagnosis and for monitoring the disease activity.
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Affiliation(s)
- Hirohiko Ono
- Department of Neurology, Tohoku University School of Medicine
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Shiozawa S, Miura Y, Hashiramoto A, Murata M, Takabayashi C, Shiozawa K, Kuroki Y. Fasciitis: what is the significance of various forms? J Clin Rheumatol 2007; 9:1-3. [PMID: 17041414 DOI: 10.1097/01.rhu.0000049694.12335.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sheehy C, Ryan JG, Kelly M, Barry M. Palmar fasciitis and polyarthritis syndrome associated with non-small-cell lung carcinoma. Clin Rheumatol 2007; 26:1951-3. [PMID: 17310269 DOI: 10.1007/s10067-007-0582-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
Abstract
A 56-year-old man presented with pain and stiffness in both shoulders and developed severe, rapidly progressive contractures of the fingers. Examination revealed subcutaneous thickening in both palms with fixed flexion deformities of all digits except the thumbs. Initial investigations including a malignancy screen were all normal/negative. Eighteen months later, he was diagnosed with metastatic non-small-cell lung carcinoma. Although rare, palmar fasciitis and polyarthritis syndrome is an important paraneoplastic syndrome for rheumatologists to be aware of, as the musculoskeletal symptoms may precede neoplastic manifestations by many months and may improve with appropriate treatment.
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Affiliation(s)
- Claire Sheehy
- Department of Rheumatology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
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Abstract
A 31-yr-old Korean woman was presented with 4-month history of bilateral hand swelling and stiffness. On clinical examination, she had a painful synovitis of both hands, wrists, knees and ankles. The radiologic and histological examinations confirmed it with palmar fasciitis and polyarthritis syndrome (PFPAS). PFPAS is an uncommon disorder characterized by progressive flexion contractures of both hands, inflammatory fasciitiis, fibrosis, and a generalized inflammatory arthritis. Although most reported cases of PFPAS have been associated with various malignancies, our patient have not been associated with malignancy during 24 months follow up period from her first symptom onset. Her symptoms were improved with moderate dose of corticosteroid and she is currently taking prednisone 5 mg daily without any evidence for internal malignancy. We present here in a young Korean patient with idiopathic PFPAS who was successfully treated with administration of corticosteroid.
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Affiliation(s)
- Yoon-Kyoung Sung
- Department of Internal Medicine, Division of Rheumatology and the Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea
| | - Moon-Hyang Park
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Dae-Hyun Yoo
- Department of Internal Medicine, Division of Rheumatology and the Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea
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Szekanecz E, András C, Sándor Z, Antal-Szalmás P, Szántó J, Tamási L, Kiss E, Szekanecz Z. Malignancies and soluble tumor antigens in rheumatic diseases. Autoimmun Rev 2006; 6:42-7. [PMID: 17110316 DOI: 10.1016/j.autrev.2006.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Paraneoplastic symptoms, caused by a malignancy, but not directly related to invasion by the tumor or its metastases are the result of a wide variety of tumor-derived biologic mediators like hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. There is some evidence that systemic inflammatory diseases, such as rheumatoid arthritis (RA), lupus, scleroderma or dermatomyositis may increase the risk for the development of malignancies, predominantly lymphoproliferative disorders. However, reports are somewhat controversial. Immunosuppressive and cytotoxic drugs used in antirheumatic therapy, such as methotrexate, cyclophosphamide, azathioprine or anti-TNF biologicals may also lead to the development of such tumors. Tumor-associated antigens may be produced by inflammatory cells and their production may be increased in RA and other autoimmune diseases.
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Affiliation(s)
- Eva Szekanecz
- Department of Oncology, University of Debrecen, Medical and Health Science Center, Móricz, Hungary.
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Kuempers P, Köhler L, Pertschy S, Krüger M, Zeidler H, Freise J. Unilateral Fasciitis of the Lower Leg. J Clin Rheumatol 2006; 12:139-41. [PMID: 16755244 DOI: 10.1097/01.rhu.0000222005.15154.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an elderly woman with a 3-month history of abdominal pain and painful swelling of her right lower leg. Magnetic resonance imaging revealed extensive fasciitis of the right superficial and deep crural fasciae. Endoscopic ultrasonography identified a tumor in the tail region of the pancreas with regional lymphatic nodal disease and suspicion of liver metastasis. The temporal relationship between the fasciitis and the pancreatic tumor suggests cancer-associated fasciitis-panniculitis syndrome. We report for the first time the incidence of the fasciitis-panniculitis syndrome in a patient with a previously undiagnosed solid pancreatic tumor.
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Affiliation(s)
- Philipp Kuempers
- Department of Rheumatology, Medical School Hannover, Hannover, Germany
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De Carli P, Boretto J, Bourgeois W, Gallucci G. Hand involvement in paraneoplastic syndrome: a case report. J Hand Surg Am 2005; 30:1087-90. [PMID: 16182072 DOI: 10.1016/j.jhsa.2005.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 04/18/2005] [Accepted: 04/18/2005] [Indexed: 02/02/2023]
Abstract
Cutaneous paraneoplastic syndromes are skin and mucous membrane changes that are associated with cancer. We report a previously healthy 76-year-old man who developed marked finger and thumb contracture, pain, and hypersensitivity of both hands who was diagnosed subsequently as having gastric carcinoma with colonic metastasis. After the gastrointestinal tumors were resected the finger and thumb contracture lessened and the pain eased. Both the temporal relationship between the changes in the hand and the neoplasm and the improvement after resection suggest a paraneoplastic syndrome.
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Affiliation(s)
- Pablo De Carli
- Hand and Upper Extremity Department, Prof Dr Carlos Ottolenghi Institute, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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András C, Csiki Z, Ponyi A, Illés A, Dankó K. Paraneoplastic rheumatic syndromes. Rheumatol Int 2005; 26:376-82. [PMID: 16091919 DOI: 10.1007/s00296-005-0005-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Paraneoplastic symptoms caused by a malignancy but not directly related to tumour invasion are the result of a wide variety of tumour-derived biologic mediators, such as hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. On the other hand, the clinical severity of the symptoms can be used as a guide to the extent of response to underlying tumour therapy. The quality of life of the patient is affected, therefore the palliative treatment of paraneoplasia is very important.
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Affiliation(s)
- Csilla András
- Department of Oncology, University of Debrecen, Medical and Health Science Center, 4012, Debrecen, Nagyerdei krt. 98, Hungary
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Chakravarty EF, Genovese MC. Associations between rheumatoid arthritis and malignancy. Rheum Dis Clin North Am 2004; 30:271-84, vi. [PMID: 15172040 DOI: 10.1016/j.rdc.2004.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There are many complex associations between rheumatoid arthritis(RA) and malignancy. Patients with rheumatic diseases on the whole appear to be at increased risk for the development of certain malignancies. The data from several studies are persuasive that the presence of RA conveys an increased risk for the development of lymphoproliferative disorders and may convey a decreased risk for the development of malignancies of the digestive tract. Understanding the complex interrelationships between RA and malignancy will lead to more accurate diagnosis of underlying pathology, more effective treatment of symptoms and underlying disease, and appropriate surveillance for the development of later complications.
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Affiliation(s)
- Eliza F Chakravarty
- Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, #203, Palo Alto, CA 94303, USA
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Affiliation(s)
- A B Alexandroff
- Department of Dermatology, Addenbrookes Hospital, CB2 2SP, Cambridge, UK
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Abstract
The relation between rheumatic syndromes and an underlying malignancy is a complex one. As a result of autoimmunity, an aberrant immune response, or the use of immunomodulatory drugs, many of the rheumatic diseases appear to pose an increased risk for the development of malignancy. Unfortunately, for many of the same reasons, the presence of an underlying malignancy can result in the development of features of rheumatic disease. Awareness of the associations between rheumatic syndromes and malignancy will aid the clinician in the accurate diagnosis of underlying pathology, more effective treatment of both the symptoms and underlying disease, and appropriate surveillance for the development of later complications.
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