A 63-year-old woman with osteoarthritis and obstructive sleep apnea treated with nasal continuous positive airway pressure (CPAP) presented with several months of worsening pain in her hands (first metacarpophalangeal joints), wrists, and feet. Radiographs of the hands and wrists performed 1 month prior showed degenerative changes but no bone erosions. Her vital signs and physical examination findings were normal. She had no redness, warmth, or swelling of any joints, and her skin examination was unremarkable. However, a deformity of the nasal bridge was noted after she was asked to remove her face mask, which she was wearing as required during the COVID-19 pandemic (Figure). She reported no history of facial trauma, recent travel, illicit drug use, or high-risk sexual behavior. The nasal deformity, which she attributed to use of her CPAP mask, had developed gradually over the past several years.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Jason E. Liebowitz, MD, Skylands Medical Group, 66 E Main St, Rockaway, NJ 07866 (Jason.firstname.lastname@example.org).
Published Online: March 17, 2022. doi:10.1001/jama.2022.2644
Conflict of Interest Disclosures: Dr Konig reported receiving grants from the Jerome L. Greene Foundation and the Peter and Carmen Lucia Buck Foundation. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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