Hypertrophic osteoarthropathy in renal cell carcinoma - A case report

Abstract

Background: Hypertrophic osteoarthropathy (HOA) is a rare clinical condition including an abnormal periosteal reaction in the long bones that causes painful swelling and tenderness of the extremities, digital clubbing, arthritis, synovitis, and joint effusions. Most cases are associated with tumorous conditions and most commonly with lung cancer. HOA has been rarely reported in association with other cancers.

Case: A patient with a history of recurrent renal cell carcinoma was referred to our clinic with bilateral leg pain, knee joint effusion, and arthritis. Simple radiography and bone scintigraphy confirmed a diagnosis of HOA. Oral non-steroidal anti-inflammatory drugs, joint fluid aspiration, and intra-articular injection of pain medications were found to be effective in the management of HOA pain.

Conclusions: HOA prognosis depends on the underlying disease, therefore, cancer treatment is critical. This case demonstrates the need to consider HOA in patients with various malignancies who present with bone or joint pain of the extremities.

Keywords: Paraneoplastic syndrome; Periostosis; Renal cell carcinoma; Scintigraphy; Secondary hypertrophic osteoarthropathy.

Fig. 1.

Photographs of the patient’s legs. Bilateral swelling is observed from above the knees to the feet.

Fig. 2.

Simple radiologic studies of the patient’s feet. A bilateral periosteal reaction indicates hypertrophic osteoarthropathy (arrows).

Fig. 3.

Whole body bone scintigraphy. Increased radiotracer uptake is observed along the appendicular bone cortex.