Forearm myo-fasciitis and arthritis in a female with metastatic ovarian carcinoma

Forearm myo-fasciitis and arthritis in a female with metastatic ovarian carcinoma Rheumatology 2018;0:1 Clinical vignette doi:10.1093/rheumatology/key087 Forearm myo-fasciitis and arthritis in a female with FIG.1 Forearm myo-fasciitis with flexor contractures due metastatic ovarian carcinoma to metastatic right ovarian carcinoma A 42-year-old female presented with progressive tighten- ing of skin of forearms, flexor contractures of wrists and fingers (Fig. 1A) and arthralgia of hand joints for 4 months. Examination revealed mild pallor, ascites and tender- ness over both wrist and MCP joints. Her ANA was negative. MRI of forearms revealed diffuse hyperintensi- ties involving the muscles of flexor compartment (Fig. 1B, white arrow, T2 fat suppressed sequence), suggestive of oedema, bright enhancement of muscles and fa- scia of flexor compartment (Fig. 1C, white arrow, T1 post-contrast). Skin biopsy showed thickened collagen (A) Flexor contracture of wrists and fingers. (B) T2 fat bundles in dermis. A contrast CT scan of the abdomen suppressed MRI of forearms showing diffuse hyperinten- showed heterogeneously enhancing space-occupying sities in the muscles of flexor compartment (white arrow). lesion in liver (Fig. 1D, black arrow), ascites and a small (C) T1 post-contrast (fat suppressed) MRI of forearm right ovarian nodule (Fig. 1E, black arrow). Serum CA-125 showing bright enhancement of muscles and fascia of level was grossly elevated (2418 U/millilitre). She under- flexor compartment (white arrow). (D) Contrast CT scan of went hysterectomy, bilateral salpingo-ophorectomy and abdomen showing heterogeneously enhancing SOL in adjuvant chemotherapy. Histopathology of ovarian tissue liver (black arrow). (E) Contrast CT scan of abdomen revealed serous cystadenocarcinoma. During follow-up showing small right ovarian nodule (black arrow). her joint symptoms were improved with partial improve- ment of contractures. 1 1 Sumantro Mondal , Debanjali Sinha , She was diagnosed as having myo-fasciitis and 1 1 Parasar Ghosh and Alakendu Ghosh polyarthritis associated with ovarian carcinoma. Palmar Department of Rheumatology, Institute of Post Graduate fasciitis and polyarthritis syndrome is a paraneoplastic Medical Education and Research, Kolkata, India rheumatological manifestation associated with carcinoma of the ovary, breast, pancreas, lung and fallopian tubes [1]. Correspondence to: Sumantro Mondal, Department of Extensive myo-fasciitis of the forearm, as seen in our patient, Rheumatology, Institute of Post Graduate Medical Education and is, however, extremely rare. Research, Doctor’s hostel, 240 A. J. C. Bose Road, Kolkata, India. E-mail: drmsumantro@gmail.com Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit References sectors to carry out the work described in this manuscript. 1 Denschlag D, Riener E, Vaith P, Tempfer C, Keck C. Palmar fasciitis and polyarthritis as a paraneoplastic Disclosure statement: The authors have declared no syndrome associated with tubal carcinoma: a case report. conflicts of interest. Ann Rheum Dis 2004;63:11778. The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key087/4955854 by Ed 'DeepDyve' Gillespie user on 12 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Forearm myo-fasciitis and arthritis in a female with metastatic ovarian carcinoma

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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com
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10.1093/rheumatology/key087
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Abstract

Rheumatology 2018;0:1 Clinical vignette doi:10.1093/rheumatology/key087 Forearm myo-fasciitis and arthritis in a female with FIG.1 Forearm myo-fasciitis with flexor contractures due metastatic ovarian carcinoma to metastatic right ovarian carcinoma A 42-year-old female presented with progressive tighten- ing of skin of forearms, flexor contractures of wrists and fingers (Fig. 1A) and arthralgia of hand joints for 4 months. Examination revealed mild pallor, ascites and tender- ness over both wrist and MCP joints. Her ANA was negative. MRI of forearms revealed diffuse hyperintensi- ties involving the muscles of flexor compartment (Fig. 1B, white arrow, T2 fat suppressed sequence), suggestive of oedema, bright enhancement of muscles and fa- scia of flexor compartment (Fig. 1C, white arrow, T1 post-contrast). Skin biopsy showed thickened collagen (A) Flexor contracture of wrists and fingers. (B) T2 fat bundles in dermis. A contrast CT scan of the abdomen suppressed MRI of forearms showing diffuse hyperinten- showed heterogeneously enhancing space-occupying sities in the muscles of flexor compartment (white arrow). lesion in liver (Fig. 1D, black arrow), ascites and a small (C) T1 post-contrast (fat suppressed) MRI of forearm right ovarian nodule (Fig. 1E, black arrow). Serum CA-125 showing bright enhancement of muscles and fascia of level was grossly elevated (2418 U/millilitre). She under- flexor compartment (white arrow). (D) Contrast CT scan of went hysterectomy, bilateral salpingo-ophorectomy and abdomen showing heterogeneously enhancing SOL in adjuvant chemotherapy. Histopathology of ovarian tissue liver (black arrow). (E) Contrast CT scan of abdomen revealed serous cystadenocarcinoma. During follow-up showing small right ovarian nodule (black arrow). her joint symptoms were improved with partial improve- ment of contractures. 1 1 Sumantro Mondal , Debanjali Sinha , She was diagnosed as having myo-fasciitis and 1 1 Parasar Ghosh and Alakendu Ghosh polyarthritis associated with ovarian carcinoma. Palmar Department of Rheumatology, Institute of Post Graduate fasciitis and polyarthritis syndrome is a paraneoplastic Medical Education and Research, Kolkata, India rheumatological manifestation associated with carcinoma of the ovary, breast, pancreas, lung and fallopian tubes [1]. Correspondence to: Sumantro Mondal, Department of Extensive myo-fasciitis of the forearm, as seen in our patient, Rheumatology, Institute of Post Graduate Medical Education and is, however, extremely rare. Research, Doctor’s hostel, 240 A. J. C. Bose Road, Kolkata, India. E-mail: drmsumantro@gmail.com Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit References sectors to carry out the work described in this manuscript. 1 Denschlag D, Riener E, Vaith P, Tempfer C, Keck C. Palmar fasciitis and polyarthritis as a paraneoplastic Disclosure statement: The authors have declared no syndrome associated with tubal carcinoma: a case report. conflicts of interest. Ann Rheum Dis 2004;63:11778. The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key087/4955854 by Ed 'DeepDyve' Gillespie user on 12 July 2018

Journal

RheumatologyOxford University Press

Published: Mar 28, 2018

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