A 69-year-old nondiabetic woman sought neurologic consultation for nonradiating left shoulder pain after her second left supraclavicular node biopsy for diffuse large cell lymphoma. She denied any extremity weakness or paresthesias. Previous treatment had consisted of CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) chemotherapy and rituximab.
Neurologic examination results were notable for diffuse hyporeflexia and a symmetrical stocking-glove distribution of sensory loss to pinprick and temperature stimuli in all extremities. Strength was normal. Rough calluses and numerous tiny puncture marks were noted on the tips of her left index and middle fingers (Figure). The skin of the fingers of the right hand and of the feet was intact. Serum glucose level and thyroid function test results were within reference ranges, and markers of neurologic autoimmunity, including anti-Hu antibodies, were negative.
Freeman WD, Cheshire WP. A Callused Clue Fingers the Diagnosis. Arch Neurol. 2005;62(3):491. doi:10.1001/archneur.62.3.491