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Amirpour A, Ghorbani P, Ghadirzadeh E, Charkazi E, Paraandavaji E. A case report of clubbing as the initial sign of systemic sclerosis sine scleroderma: A rare possible presentation. Clin Case Rep 2023; 11:e8090. [PMID: 37867549 PMCID: PMC10587653 DOI: 10.1002/ccr3.8090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Key Clinical Message Even in the absence of characteristic cutaneous symptoms of scleroderma, systemic sclerosis should be considered in the differential diagnosis of patients initially diagnosed with idiopathic interstitial lung disease. Abstract Systemic sclerosis (SSc) is an idiopathic connective tissue disorder characterized by multisystem involvement. Although skin thickening is a hallmark manifestation of SSc, a subset known as systemic sclerosis sine scleroderma (ssSSc) presents with internal organ involvement and positive serologic markers in the absence of significant cutaneous manifestations. We report the case of a 36-year-old Iranian woman who presented with clubbing as an initial symptom of ssSSc. Notably, clubbing as the sole initial sign of the disease has not been previously reported. Timely diagnosis of ssSSc is crucial to facilitate appropriate treatment and prevent disease progression. Physicians should adopt a comprehensive approach when evaluating patients presenting with limited clinical features, as they might be indicative of underlying ssSSc.
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Affiliation(s)
- Anahita Amirpour
- Department of RheumatologyShahid Beheshti University of Medical SciencesTehranIran
| | - Parastoo Ghorbani
- Department of Internal MedicineMazandaran University of Medical SciencesSariIran
| | - Erfan Ghadirzadeh
- Cardiovascular Research CenterMazandaran University of Medical SciencesSariIran
| | | | - Elham Paraandavaji
- Skull Base Research Center, Loghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
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Impact of highly effective CFTR modulator therapy on digital clubbing in patients with cystic fibrosis. J Cyst Fibros 2022; 21:861-865. [DOI: 10.1016/j.jcf.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/21/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
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Abstract
Hypertrophic osteoarthropathy (HOA) is an orphan syndrome characterized by abnormal proliferation of the skin and osseous tissues at the distal parts of the extremities. The main clinical features are: a peculiar bulbous deformity of the tips of the digits conventionally described as "clubbing," periosteal proliferation of the tubular bones, and synovial effusions. In most instances, HOA develops a reaction to a severe internal illness, such as lung cancer, cyanotic heart disease, or liver cirrhosis. There is a subgroup of patients who do not have underlying pathology. Such cases are classified as having primary HOA. Digital clubbing is easy to recognize. Any patient with newly developed digital clubbing should undergo careful search for an underlying illness with special attention to intra-thoracic pathologies. Painful HOA is treated with non-steroidal anti-inflammatory medications. Vascular endothelial growth factor and prostaglandin E2 have been proposed as key bone proliferating mediators.
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Affiliation(s)
- Manuel Martínez-Lavín
- Chief Rheumatology Department. National Institute of Cardiology, Juan Badiano 1, 14080, Mexico City, Mexico.
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Acute and Chronic Respiratory Failure in Cancer Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123817 DOI: 10.1007/978-3-319-74588-6_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2016, there was an estimated 1.8 million new cases of cancer diagnosed in the United States. Remarkable advances have been made in cancer therapy and the 5-year survival has increased for most patients affected by malignancy. There are growing numbers of patients admitted to intensive care units (ICU) and up to 20% of all patients admitted to an ICU carry a diagnosis of malignancy. Respiratory failure remains the most common reason for ICU admission and remains the leading causes of death in oncology patients. There are many causes of respiratory failure in this population. Pneumonia is the most common cause of respiratory failure, yet there are many causes of respiratory insufficiency unique to the cancer patient. These causes are often a result of immunosuppression, chemotherapy, radiation treatment, or hematopoietic stem cell transplant (HCT). Treatment is focused on supportive care and specific therapy for the underlying cause of respiratory failure. Noninvasive modalities of respiratory support are available; however, careful patient selection is paramount as indiscriminate use of noninvasive positive pressure ventilation is associated with a higher mortality if mechanical ventilation is later required. Historically, respiratory failure in the cancer patient had a grim prognosis. Outcomes have improved over the past 20 years. Survivors are often left with significant disability.
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Clubbing masquerading as a vascular malformation! Postgrad Med J 2019; 95:514. [DOI: 10.1136/postgradmedj-2019-136787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/03/2022]
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Jenkins V, Henrique de Mello Souza C, de Lorimier LP, de Toledo-Piza E. Squamous Cell Carcinoma of the Penis with Pulmonary Metastasis and Paraneoplastic Hypertrophic Osteopathy in a Dog. J Am Anim Hosp Assoc 2017; 53:277-280. [PMID: 28792794 DOI: 10.5326/jaaha-ms-6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Squamous cell carcinoma of the penis was diagnosed by incisional biopsy of a penile mass in a 12 yr old intact male beagle dog presenting with hemorrhagic discharge from the prepuce. Penile amputation, orchiectomy with scrotal ablation, and scrotal urethrostomy were performed. Hypertrophic osteopathy secondary to pulmonary metastatic disease occurred 10 mo after the surgery. Palliative treatment with piroxicam was administered and led to complete resolution of the clinical signs of the pain. Sixteen months following surgery, the dog presented with significant dyspnea and anorexia and was euthanized due to poor prognosis. This case report describes a rare penile tumor, squamous cell carcinoma. Consequent paraneoplastic hypertrophic osteopathy and its palliative treatment are also reviewed.
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Affiliation(s)
- Victoria Jenkins
- From the University of Florida, Gainesville, Florida (V.J., C.H.d.M.S.); Hôpital Vétérinaire Rive-Sud, Brossard, Quebec, Canada (L-P.d.L.); IPEV, Rio de Janeiro, Brazil (E.d.T-P.)
| | - Carlos Henrique de Mello Souza
- From the University of Florida, Gainesville, Florida (V.J., C.H.d.M.S.); Hôpital Vétérinaire Rive-Sud, Brossard, Quebec, Canada (L-P.d.L.); IPEV, Rio de Janeiro, Brazil (E.d.T-P.)
| | - Louis-Phillippe de Lorimier
- From the University of Florida, Gainesville, Florida (V.J., C.H.d.M.S.); Hôpital Vétérinaire Rive-Sud, Brossard, Quebec, Canada (L-P.d.L.); IPEV, Rio de Janeiro, Brazil (E.d.T-P.)
| | - Evandro de Toledo-Piza
- From the University of Florida, Gainesville, Florida (V.J., C.H.d.M.S.); Hôpital Vétérinaire Rive-Sud, Brossard, Quebec, Canada (L-P.d.L.); IPEV, Rio de Janeiro, Brazil (E.d.T-P.)
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Dubrey S, Pal S, Singh S, Karagiannis G. Digital clubbing: forms, associations and pathophysiology. Br J Hosp Med (Lond) 2016; 77:403-8. [DOI: 10.12968/hmed.2016.77.7.403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Dubrey
- Consultant Cardiologist in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex UB8 3NN
| | - Shrestha Pal
- FY1 in General Internal Medicine in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
| | - Sarneet Singh
- CT2 in Cardiology in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
| | - Georgios Karagiannis
- Consultant Cardiologist in the Department of Cardiology, Hillingdon and Mount Vernon Hospitals NHS Foundation Trust, Middlesex
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Callemeyn J, Van Haecke P, Peetermans WE, Blockmans D. Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance. Acta Clin Belg 2016; 71:123-30. [PMID: 27104368 DOI: 10.1080/17843286.2016.1152672] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Digital clubbing and hypertrophic osteoarthropathy (HOA) form a diagnostic challenge. Subtle presentations of clubbing are often missed. The underlying pathophysiology remains unclear. Establishing a differential diagnosis based on nonspecific signs can be cumbersome. Finally, the prognostic value of clubbing and HOA remains unclear. OBJECTIVE This article reviews clinical criteria and pathophysiology of clubbing and HOA. A diagnostic algorithm is proposed, based on etiology and current insights. The prognostic impact on associated diseases is discussed. METHODS The Internet databases Medline and Embase were searched. Articles were selected based on relevance of abstract, article type and impact of the journal. RESULTS Diagnostic criteria include Lovibond's profile sign, distal/interphalangeal depth ratio and Schamroth's sign. Three pathophysiological causes of clubbing can be distinguished: hypoxia, chronic inflammation and aberrant vascularization. A prominent role for vascular endothelial growth factor is suggested. Associated symptoms and clinical signs should guide the initial diagnostic evaluation. Finally, clubbing is a negative prognostic factor in certain pulmonary disorders, including cystic fibrosis.
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Monge E, Coolen-Allou N, Mascarel P, Gazaille V. [Pulmonary MALT lymphoma and paraneoplastic syndromes]. Rev Mal Respir 2016; 33:799-803. [PMID: 27155897 DOI: 10.1016/j.rmr.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Primary pulmonary lymphoma is a rare disease; diagnosis is often delayed because of atypical clinical presentation and slow progression. OBSERVATION A 42-year-old woman consulted because of haemoptysis. Chest CT-scan showed multiple nodular calcified masses. A lung biopsy led to the diagnosis of pulmonary amyloidosis with pulmonary MALT lymphoma (mucosa-associated lymphoid tissue). The patient developed two paraneoplastic syndromes: a hypertrophic osteoarthropathy and mucinosis. CONCLUSION Multiple nodular amyloidosis can be a mode of presentation for pulmonary lymphoma. Paraneoplastic syndromes must be systematically considered and can help in early diagnosis of the disease and its relapse.
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Affiliation(s)
- E Monge
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - N Coolen-Allou
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion
| | - P Mascarel
- Service de radiologie, clinique Sainte-Clotilde, 127, route de Bois-de-Nèfles, 97492 Sainte-Clotilde, Réunion
| | - V Gazaille
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Wortsman X, Alvarez S. Colour Doppler ultrasound findings in the nail in cystic fibrosis. J Eur Acad Dermatol Venereol 2014; 30:149-51. [PMID: 25074366 DOI: 10.1111/jdv.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- X Wortsman
- Department of Radiology and Dermatology, IDIEP-Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - S Alvarez
- Department of Dermatology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
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Rutherford JD. Response to letter regarding article, "Digital clubbing". Circulation 2013; 128:e449. [PMID: 24297822 DOI: 10.1161/circulationaha.113.005707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John D Rutherford
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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