Indurated reticulate palmar erythema as a sign of paraneoplastic palmar fasciitis and polyarthritis syndrome.
A 62-year-old woman presented with a 6-month history of polyarthritis. She had also noted a 2-month history of indurated palmar erythema and increasing bilateral hand swelling and stiffness. A biopsy from the area of palmar erythema showed interstitial fibroplasia within the dermis and subcutis representing a palmar fibromatosis. This presentation appears to belong to the spectrum of palmar fasciitis and polyarthritis syndrome. Rheumatologists have recognised this syndrome as a paraneoplastic disorder and subsequent investigations in our patient revealed an elevated cancer antigen 125 and an inoperable ovarian carcinoma. Indurated palmar erythema is a sign that is not widely recognised by dermatologists as a clue for this paraneoplastic syndrome, and skin biopsy demonstrating dermal and subcutaneous fibroplasia may help in diagnosis in the absence of advanced signs of palmar fasciitis.
Preda
Veronica A
VA
Skin & Cancer Foundation, Darlinghurst, NSW, Australia. vpreda@scfa.edu.au
Frederiksen
Peter
P
Kossard
Steven
S
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D001168:Arthritis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004890:Erythema / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005208:Fasciitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006229:Hand Dermatoses / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D018570:Risk Assessment; D016896:Treatment Outcome