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• W4387248115 abstract "SESSION TITLE: Lung Cancer Case Report Posters 13 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Palmar fasciitis and polyarthritis syndrome (PFPA) is rare and consists of painful symmetrical swelling and finger flexion contractures with associated vascular motor instability, mimicking complex regional pain syndrome (1). The most pertinent feature of PFPA is its association with underlying malignancies (2). Reported evidence highlights PFPA to be associated with advanced or metastatic malignancies. We present a case of PFPA in association with early detection of pulmonary adenocarcinoma. CASE PRESENTATION: A 68-year-old man presented with sudden onset of bilateral hand swelling involving the fingers and wrists. He was a former 45-pack–year smoker, quit 30 years ago. He had a history of treated papillary thyroid carcinoma and a right hemidiaphragm paralysis secondary to pacemaker placement. Lung exam revealed vesicular breath sounds without adventitious sounds. On musculoskeletal examination, there was diffuse symmetrical dorsal edema with inability to stretch the 3rd to 5th digits of both hands. Laboratory values showed a C-reactive protein of 2.4 mg/dL (0.8) and normal serum uric acid. Additionally, ANA, anti-CCP antibodies, rheumatoid factor, and HLA-B27 were all negative. He was diagnosed with seronegative inflammatory polyarthritis and was started on a prednisone taper followed by weekly oral methotrexate. His swelling subsided 2 months later, however flexion contractures in the 3rd to 5th digits of both hands persisted despite a full course of Occupational Therapy. Based on the refractoriness of his symptoms to conventional therapies for arthritis, alternative diagnoses were entertained, including PFPA secondary to underlying malignancy. Noting the significant history of smoking and thyroid carcinoma, he underwent a low-dose chest CT. Radiographic findings were significant for a spiculated irregular 1.7 x 1.0 cm nodule of the left lung apex. A follow-up full body PET/CT scan showed increased uptake in the left upper lung but no evidence of regional or distant metastatic disease. Pathology results following biopsy revealed moderately differentiated invasive adenocarcinoma. Given his comorbid right-sided diaphragmatic paralysis and early stage of the disease, he received stereotactic body radiation therapy (SBRT). DISCUSSION: The US Preventive Services Task Force guidelines for lung carcinoma screening recommend the evaluation of individuals ages 50 to 80 who have a 20 pack-year smoking history and are currently smoking or who have quit within the past 15 years. Our patient did not fulfill these criteria and by these guidelines the low-dose chest CT was not indicated. However, screening for malignancy should extend to patients with additional clinical suspicion, as in our patient who had a history of prior malignancy, smoking, and poor response to conventional therapies for arthritis. Prompt identification of these features led to an early diagnosis of pulmonary adenocarcinoma. The literature had previously associated PFPA with advanced or metastatic malignancies. Thus, this is a unique case in which the presence of PFPA led to an otherwise unprompted diagnosis of early-stage malignancy. CONCLUSIONS: Recognition of PFPA should prompt screening patients for age-related malignancy, aimed at achieving an early detection and avoidance of progression to metastatic disease. Flexion contractures from PFPA are usually resistant to treatment but are more likely to resolve with treatment of an underling malignancy (3). REFERENCE #1: Manger B, Schett G. Palmar fasciitis and polyarthritis syndrome-systematic literature review of 100 cases. Semin Arthritis Rheum. 2014;44(1):105-11. REFERENCE #2: Okumura H, Ishino H, Yokoi D, Matsumura M. Palmar Fasciitis and Polyarthritis Syndrome Associated with Lung Adenocarcinoma. Intern Med. 2022;61(14):2221-5. REFERENCE #3: Strunz PP, Schmalzing M. [Paraneoplastic syndromes in rheumatology]. Z Rheumatol. 2023. DISCLOSURES: No relevant relationships by Larabe Farrukh No relevant relationships by Simrin Kooner No relevant relationships by Ruben Peredo-Wende No relevant relationships by Lisa Rosenberg No relevant relationships by Sumbal Wajid" @default.
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• W4387248115 date "2023-10-01" @default.
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• W4387248115 title "PALMAR FASCIITIS AND POLYARTHRITIS SYNDROME AS INITIAL MANIFESTATION OF LUNG MALIGNANCY" @default.
• W4387248115 doi "https://doi.org/10.1016/j.chest.2023.07.2848" @default.
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