pulmonary tuberculosis. Hypertrophic osteoarthropathy in association ...

Hypertrophic osteoarthropathy in association with pulmonary tuberculosis. P Kelly, P Manning, P Corcoran and L Clancy Chest 1991;99;769-770 DOI 10.1378/chest.99.3.769 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/99/3/769

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7

Goulon

M, Escourolle

par gliome

R, Augustin

P. Hyperventilation

bulbo-protuberantiel.

Rev

Table

primitive

Neurol

(Paris)

presenting

with

1969;

1 -Main

S, Lazlo

G. Cerebral

tumour

Neurosurg

Psych

J Neurol

tilation. 9 ‘flnaztepe

B, ‘flnaztepe

as sustained

10 Nakasu

K,

Y, Nakasu Arch

F.

Neurol

Jpn

1982;

J

M,

J.

1988;

(RT-23)

Tuberculosis

1

35

1 TU

a review

and

2

hyperventilation

(letter).

48

Paul Kelly, MA.,

44

staining

M.D.; Patrick Manning, D.CH., D.PH.; FC.C.P

1 TU +

MB.,

the

D.CH.;

and

The

osteoarthropathy;

NSA!

patients

mation.

All three

only

osteoarthropathy

and

joints,

is a systemic

soft

another

tissue

disease

intrathoracic

disease.

Hypertrophic

by

or all ofthe

several digits;

(2)

thickness case

develops

in

commonly

new

bone

in

commonly

of

neurovascular chronic

sweating. Most

cases

changes

of

3,

and of

in case

erythema,

of

seen

bronchogenic

‘

today

other

and

ankles,

knees,

and

and

are

feet,

increased

in pregnancy,”2

two

cases

stated presence

of severe

that

and

decades,

two

with

associated

intrathoracic

HOA

neoplasms,

not

another

We

present

three tuberculosis.

*Fmm Peamount Reprint requests: Dublin,

Ireland

case

been

described

tuberculosis.’’

occur

in only It has

in tuberculosis,’

underlying

CASE

pulmonary

abuse.’

has

pulmonary

does

suggests

purgative

HOA

and

been

its

pathology.’

histories

of patients

Hospital, Newcastle Dr. Kelly, Peamount

HOA were

initial

of the

in

association positive

present

lower

the

Patient

in Table

2 was

following

craniotomy

1.

of HOA.

In

1 is alive

alive

patient

HOA

bronchogenic

Patient

and

and

the

presence

identified.

in

forearms.

analgesia,

underlying

presentation,

presentation

the

are given

for

to explain

presentation. after

or increased was

drugs,

patients

pathology

tuberculosis.

Radiologically,

investigated

There were no clear pointers in these patients. The pulmonary with

involvement

disease.

This

Why cases

for

the is

of both has

with on direct

Co, Dublin, Ireland. Hospital, Newcastle County,

been

and

3 died

and

well

when

three

years

for a pyogenic

brain

HOA

cavitation,

in case but

1 and

both

hence

may

longer

time.

continue The

pathogenesis

of

HOA

changes are an increase tissue in association with There is increased blood shunted

through

areas

flow to the

have

had

This

vagus

nerve is unknown

neuronal.’ ischemic

Abnormal tissue distal

may

be

may

not always

the

stimulus

ro’ due

is

as

pathway

is

the

extensive

in the

other

2 and

3 had

active

tuberculosis

may

have

two been

allowed

the

provoking agent period of time.

unknown,

venous

of the extremities

not

patients

and growth subperiosteal flow to the

arterial

and

discussed.’’

to become irreversible or the to be secreted for a prolonged

HOA

the

lungs,

resolved

and

to the pathogenesis of HOA tuberculosis was extensive,

previously

unexplained,

a considerably

the

REPORTS

All three

after

over NSAI

for-

intake,

life-style.

clubbing

treatment.

and

bone

alcohol

changes

Finger with

wrists

new

pulmonary

tenderness

pathology

years

their

neurovascular

to

other

noncompliant

and Hodgkin’s disease of the mediastinum. It is also seen in severe cystic fibrosis, bronchiectasis, chronic empyema, and lung abscess,89 occasionally in hepatic disease,b0 and In the last

any

2’/2

disrupt cavitary

resolved

the

of excessive

and drugs.

DISCuSsION

joints

hands

paresthesia,

HOA

after

this

had

were

or other

seen

in

stiffness subperiosteal

tissue.

1 . Details

patients was

and

a history

had

tuberculosis

six years

last

patients

of HOA

response

well

3 did

all patients

Symptoms

antituberculosis

is

formation;

the

the

the

three

tuberculosis,

to first-line

had advanced

abnormalities:

and elbows; (4) increased thickness of the subcutasoft tissue in the distal one-third ofthe arms and legs;

including

loss;

abscess.

osteoarthropathy

changes

most

of

had

of subcutaneous

The

disorder

most

following

periosteal

arthritis-like tissues,

which

process,

characterized

neous and (5)

Yes

weight

showed

2 and

patients

of the

no case

symmetrical

No loss;

Cough;

of pain

patients

in cases

carcinoma

ofthe

pain

for Mycobacterium

sensitive

roentgenograms

All three None

fully

complained

and

but

of sputum

were

ankles,

nonsteroidal

anti-inflammatory

periarticular

20 yr; 2 yr;

culture

isolates

resolved

HOA = hypertrophic

with

chest

fever

patients with advanced cavitary pulmonary tuberculosis presented with HOA. No other pathology to explain the osteoarthropathy was detected. The osteoarthropathy responded symptomatically to NSA! drugs and treatment oftuberculosis but resolved radiologically in only one patient. (Chest 1991; 99:769-70)

bones,

No)

sweats;

with Pulmonary

D.CH.,

ypertrophic

loss;

night

Cough; weight

1 yr previously

male

(1) clubbing

1 yr previously

10 TU +

Osteoarthropathy

PatriciaCorcoran,M.B., and Lrke Clancy, M.D.,

association

Weight

malaise

Tuberculosis*

white

None

+

Clubbing

fever;

in Association

Three

Finger Symptoms

6:636-37

Hypertrophic

rarely

HOA

with

of

Ann

3

wrists,

IIt1CntS

neurogenic

report

57:165-71

of central

History

yr

23:269-75

Central

case

Status

Case presenting

1981;

Handa

tumour:

Chir

81:535-49

Pediatr

Age,

hyperven-

Microgliomatosis

K.

pontine

Mechanisms

1965;

Turk

5, Matsuda with

ofliterature.

11 Plum

Yalaz

hyperventilation.

hyperventilation

(3)

ofThree

Features

Mantoux

636-39 8 Langel

H

Clinical

121:

but

the

of vascular new hone extremities,

to

earliest

connective formation. but this

communications

is

close

to

The increase in blood to a reflex mechanism with

afferent

pathway.

The

efferent

than intrathoracic masses or tissue, or to these massesas or pulmonary damage but

is probably

to initiate

improve

hormonal,

this

blood

when HOA is seen in association Hypertrophic osteoarthropathy CHEST

reflex;

flow

to the

however,

vagotomy

extremities,

with intrathoracic affecting mainly I 99 I 3 I MARCH,


rather

even

disease.21 the lower 1991

769

limbs

has

aortic

grafts

been

described

(Dacron

in

association

with

Spontaneous

Regression of Cardiomyopathy in a Patient with the Acquired Immunodeficiency Syndrome*

abdominal

grafts).#{176} REFERENCES

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of4,600

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4:404-05

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*From

osteoarthropathy Can

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of peripheral

a thin venous

WBC

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in

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data

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was

course

onset

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Child

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= ventricular

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Med

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Mercy tSenior lDirector, Reprint

the

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of Cardiology,

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Regression

Department

of Medicine,

1409

Pittsburgh

Locust,

of Cardiornyopathy


(Hakas

The

15219

Qenerelovich)

Hypertrophic osteoarthropathy in association with pulmonary tuberculosis. P Kelly, P Manning, P Corcoran and L Clancy Chest 1991;99; 769-770 DOI 10.1378/chest.99.3.769 This information is current as of July 10, 2011 Updated Information & Services Updated Information and services can be found at: http://chestjournal.chestpubs.org/content/99/3/769 Cited Bys This article has been cited by 1 HighWire-hosted articles: http://chestjournal.chestpubs.org/content/99/3/769#related-urls Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.chestpubs.org/site/misc/reprints.xhtml Reprints Information about ordering reprints can be found online: http://www.chestpubs.org/site/misc/reprints.xhtml Citation Alerts Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to the right of the online article. Images in PowerPoint format Figures that appear in CHEST articles can be downloaded for teaching purposes in PowerPoint slide format. See any online figure for directions.
