Want to take quizzes and track your credits?
A woman in her late 40s presented with rapidly progressive redness and stiffness of both hands, accompanied by 2 months of multiple finger joint and right shoulder pain. Results of autoimmune serology, including antinuclear antibody, C3 and C4, rheumatoid factor, and Scl-70 antibody tests, were negative. Raynaud phenomenon was not seen. There was an absence of nailfold capillary changes and distal digital pitting.
The patient was treated with nonsteroidal anti-inflammatory drugs, systemic steroid therapy, and disease-modifying antirheumatic drugs (ie, hydroxychloroquine), but symptoms persisted. Two weeks after treatment initiation, multiple tender nodules developed over the palms and interphalangeal joints, and flexion contractures continued (Figure, A). Incisional skin biopsy of the palmar nodules (Figure, B and C) and computed tomography (CT) were performed. Results of the CT demonstrated bilateral ovarian tumors with highly suspect peritoneal metastases.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
C. Palmar fasciitis and polyarthritis syndrome
Histopathologic examination revealed increased fibroblasts with fibrosis from dermis to subcutis (Figure, B and C). The fascia was not included in the biopsy specimen.
For the ovarian cancer, the patient received neoadjuvant chemotherapy with carboplatin and paclitaxel at 3-week intervals for 3 cycles. Results of the follow-up CT showed partial regression in the left ovarian tumor and a stationary right ovarian tumor. The patient underwent debulking surgery with bilateral salpingo-oophorectomy. The pathology of the ovarian tumors demonstrated high-grade serous carcinoma. Regarding her hands, the patient reported partial resolution of swelling, pain, and nodularity, but no improvement in flexion contractures.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Corresponding Author: Ren-Feng Liu, MD, Department of Dermatology, Chang Gung Memorial Hospital, No. 222, Maijin Rd, Anle Dist, Keelung City, 20401, Taiwan (firstname.lastname@example.org).
Published Online: November 11, 2020. doi:10.1001/jamadermatol.2020.4386
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
You currently have no searches saved.