Unilateral Swelling and Functional Impairment of Unknown Origin in the Right Arm
A 66-year-old man presented with a 3-month history of progressive painful swelling and impaired function of the right arm. He was not aware of any foregoing trauma or relevant previous illness (e.g., venous insufficiency or Graves’ disease). The striking laboratory findings were leukocytosis (14.39/nL) and elevated CRP (5.5 mg/dL). Brachial vein thromboses was ruled out by duplex sonography. Radiography of the right wrist showed diffuse periosteal calcifications along the diaphyses of the long bones in the hand and lower arm, compatible with hypertrophic osteoarthropathy (synonym: Pierre Marie–Bamberger syndrome). This disease often accompanies neoplasia or precedes a malignant tumor. The patient had no known primary tumor but had smoked for many years. Thoracic radiography and computed tomography were carried out, revealing a right-sided Pancoast tumor without compression of veins. Histopathology yielded the diagnosis of non-small-cell lung cancer, and palliative radiochemotherapy was given. This case illustrates the importance of considering rare syndromes after exclusion of more commonly occurring diseases.
Felix Carl Reinecke, Dr. med. Lars Becker, Prof. Dr. med. Marcus Jäger, Klinik für Orthopädie und Unfallchirurgie,
Universitätsklinikum Essen, email@example.com
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Reinecke FC, Becker L, Jäger M: Unilateral swelling and functional impairment of unknown origin in the right arm. Dtsch Arztebl Int 2019; 116: 143. DOI: 10.3238/arztebl.2019.0143