A Paraneoplastic Case of Palmar Fasciitis and Polyarthritis Syndrome

Muhammad Haroon; Mark Phelan

Nat Clin Pract Rheumatol. 2008;4(5):274-277.

The Patient's Laboratory Measurements at the Time of Admission
Investigation	Result
C-reactive protein	<10 mg/l (normal range 1-10 mg/l)
Hemoglobin	10.7 g/dl (normal range 13-17 g/dl
Liver and kidney functions	Normal
Erythrocyte sedimentation rate	23 mm/h (normal range <30 mm/h)
Rheumatoid factor	Negative (<15 IU/ml)
Anti-nuclear antibodies	Negative
Extractable nuclear antibodies	Negative
Serum creatine kinase	56 U/l (normal range 0-195 U/l)
Lactate dehydrogenase	326 U/l (normal range 266-500 U/l)
X-rays of hands, wrists and knees	No erosions, essentially normal
CT of abdomen, pelvis, thorax and brain	No residual tumor or metastasis
Technetium-99 bone scan	Slight increased activity in multiple small joints of hands, otherwise normal
Viral hepatitis serology	Negative
HbA1C	5.2% (normal range 4-6%)
Skin biopsy	Increased fibrosis of the dermis
Tumor markers CA-125 CA-19.9 CA-15.3 Alpha-fetoproteins	17 U/ml (normal range 0-30 U/ml) 21 U/ml (normal range 0-31 U/ml) 12 U/ml (normal range 0-32 U/ml) 2 ng/ml (normal range 0-8 ng/ml)
Albumin	28 g/l (normal range 35-50 g/l)
Calcium	2.18 mmol/l (normal range 2.1-2.7 mmol/l)
Ferritin	25 µg/l (normal range 17-360 µg/l)
Vitamin B12	347 µg/l (normal range 160-1000 µg/l)

Differential Diagnosis
Systemic sclerosis Complex regional pain syndrome Dupuytren's disease Eosinophilic fasciitis Clinical rheumatoid arthritis

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A Paraneoplastic Case of Palmar Fasciitis and Polyarthritis Syndrome

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