Omission of Hypertrophic Osteoarthropathy Delays the Early Diagnosis of a Lung Neoplasm

Introduction. Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by periostitis of the long (tubular) bones, clubbing of the digits and arthritis. Less than 4,5% of the lung cancer patients developed hypertrophic osteoarthropathy as a paraneoplastic manifestation.

Case presentation. We present a case of a 59 year old man, smoker presents for 18 months recurrent symmetric arthritis of knee. He lost 6 kilograms and he had no pulmonary symptoms. Physical examination revealed digital clubbing with watch-glass nails painless of all fingers, joint effusion of the knees. Laboratory results revealed only inflammatory syndrome and anaemia of chronic disease. The X-rays revealed periosteal appositions at the tibia, fibula and femur, mass in the left lower lobe. Computed tomography confirmed lung tumor and biopsy showed the malignant character of the tumor.

Conclusion. The index of suspicion for OAH should be high in a patient with symmetrical arthritis who associates Hippocratic fingers.