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The New England Journal of MedicineSecondary Hypertrophic Osteoarthropathy

Uncovering the Links: Secondary Hypertrophic Osteoarthropathy and Its Association with Lung Cancer

In a detailed clinical examination, a 55-year-old female patient’s chronic joint pain led to the diagnosis of secondary hypertrophic osteoarthropathy, uncovering an underlying non-small-cell lung cancer. This case emphasizes the critical nature of comprehensive symptom evaluation in diagnosing associated malignancies.

Key Points:

  • A 55-year-old woman with a significant smoking history presented with prolonged pain across various joints.
  • Physical examination revealed clubbing and skin thickening on her fingers and toes, without noticeable erythema or joint swelling.
  • Despite normal cardiopulmonary findings, radiographs highlighted symmetric periostitis of multiple tubular bones.
  • The clinical triad of arthropathy, periostitis, and clubbing raised suspicions of hypertrophic osteoarthropathy.
  • Subsequent investigations identified a large mass in the left lung, later confirmed as non-small-cell lung cancer via biopsy.
  • The diagnosis of secondary hypertrophic osteoarthropathy was linked to the underlying lung malignancy.
  • Despite initiating systemic chemotherapy, the patient succumbed to pneumonia within two months.

In almost 90% of cases, hypertrophic pulmonary osteoarthropathy (HPO) is associated with intrathoracic neoplasm and 80% of these are lung cancers.

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