Dilli Ram Poudel et al. and Quality. https://www.hcup-us.ahrq.gov/tools_ 13 HCUP CCS. Healthcare Cost and Utilization Project software.jsp (10 September 2017, date last accessed). (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. HCUP Databases. Published March 2017. 16 Houchens R, Ross D, Elixhauser A, Jiang J. Nationwide https://www.hcup-us.ahrq.gov/nisoverview.jsp (31 July Inpatient Sample (NIS) Redesign Final Report. 2014. 2017, date last accessed). HCUP Methods Series Report # 2014-04 ONLINE. April 4, 2014. U.S. Agency for Healthcare Research and Quality. 14 Radensky PW, Berliner E, Archer JW, Dournaux SF. http://www.hcup-us.ahrq.gov/reports/methods/methods. Inpatient costs of major cardiovascular events. Am J jsp (12 October 2015, date last accessed). Cardiovasc Drugs 2001;1:20517. 15 HCUP-US Tools & Software Page. Healthcare 17 Bureau of Labor Statistics. CPI Inflation Calculator. https:// Cost and Utilization Project (HCUP). July 2017. www.bls.gov/data/inflation_calculator.htm (2 November Rockville, MD: Agency for Healthcare Research 2017, date last accessed). Rheumatology 2018;57:1622 doi:10.1093/rheumatology/key087 Clinical vignette Advance Access publication 28 March 2018 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 . 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: email@example.com Funding: No specific funding was received from any bodies in the public, commercial or not-for-profit Reference 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: firstname.lastname@example.org 1622 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/9/1622/4955854 by Ed 'DeepDyve' Gillespie user on 28 August 2018
Rheumatology – Oxford University Press
Published: Sep 1, 2018
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