□
PICTURES IN CLINICAL MEDICINE
□
Hypertrophic Osteoarthropathy Associated with Esophageal Cancer Takamasa Murosaki 1, Katsusuke Mori 2, Takao Nagashima 1 and Seiji Minota 1 Key words: esophageal cancer, hypertrophic osteoarthropathy, malignancy (Intern Med 54: 357-358, 2015) (DOI: 10.2169/internalmedicine.54.3458)
Picture.
A 58-year-old man was admitted to a local hospital with a five-month history of fatigue, peripheral edema, generalized myalgia and arthralgia. He had lost 30 kg of weight over the previous six months. The findings of gastrointestinal endoscopy and a biopsy led to a diagnosis of squamous
cell carcinoma of the esophagus, and the patient was referred to our hospital for further management. He had symmetrical polyarthritis involving both the large and small joints. In addition, his hands and feet were swollen bilaterally, and prominent digital clubbing was noted. Radiographs
１
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan and ２Department of Surgery, Jichi Medical University, Japan Received for publication June 10, 2014; Accepted for publication July 6, 2014 Correspondence to Dr. Takao Nagashima,
[email protected]
357
Intern Med 54: 357-358, 2015
DOI: 10.2169/internalmedicine.54.3458
revealed noticeable periosteal thickening of almost all long bones, including the humerus, radius, ulna, femur, tibia, fibula, metacarpals and proximal and middle phalanges (Picture). Accordingly, the patient was diagnosed with hypertrophic osteoarthropathy (HOA) associated with esophageal cancer. The cancer was inoperable; therefore, only gastrostomy was performed. Although there have been a dozen case reports of HOA associated with esophageal cancer (1), the full-blown presentation observed in the present patient is
quite rare. The authors state that they have no Conflict of Interest (COI).
Reference 1. Morita M, Sakaguchi Y, Kuma S, Kajiyama K, Sugio K, Yasumoto K. Hypertrophic osteoarthropathy associated with esophageal cancer. Ann Thorac Surg 76: 1744-1746, 2003.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
358
