| 英文摘要 |
A 56-year-old housewife presented with a 2-month history of symmetrical polyarthritis (A) and bilateral carpal tunnel syndrome. Swollen induration with retraction of the palmar fascia and contracture of fingers were noted (B). There was no history or associated symptom of any major medical and rheumatological disease. The laboratory revealed WBC 8620/mm3, hemoglobin 13.1 mg/dL, platelet 274,000/mm3, CRP 1.03 mg/dL, ESR 40 mm/hr; urinalysis and biochemistry, within normal range. ANA, RF, anti-CCP antibody (Ab), anti-dsDNA Ab, and anti-ENAs including anti-scl-70 Ab were all negative. X-ray of hands showed mild osteoarthrosis and soft tissue swelling over small joints of hands (C), whereas MRI, mild synovitis over joints of hands with tenosynovitis of both flexor and extensor tendon sheaths, and soft tissue edema, suggesting non-specific soft tissue inflammation, around wrists and palms (D). The treatment response to low dose prednisolone and NSAIDs was limited. One month later, she was hospitalized for acute rapid progressive shortness of breath for which massive pleural effusion, Rt, was noted. Cytology of pleural effusion demonstrated metastatic adenocarcinoma. No primary origin by CT scans of chest and abdomen, either PET scan, but only CA-125 556 U/mL (<35 U/mL) was found. Paraneoplastic palmar fasciitis and polyarthritis syndrome (PFPAS) was impressed. A literature review found 10 other cases of PFPAS associated with ovarian carcinoma. Significant improvement was observed after successive chemotherapies. |
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