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JAMA Dermatology Clinicopathological Challenge
November 11, 2020

Rapidly Progressive Stiffness and Nodularity of Both Hands in a Middle-aged Woman

Author Affiliations
  • 1Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Keelung, and Taipei, Taiwan
  • 2College of Medicine, Chang Gung University, Taoyuan, Taiwan
JAMA Dermatol. 2021;157(1):107-108. doi:10.1001/jamadermatol.2020.4386

A woman in her late 40s presented with rapidly progressive redness and stiffness of both hands, accompanied by 2 months of multiple finger joint and right shoulder pain. Results of autoimmune serology, including antinuclear antibody, C3 and C4, rheumatoid factor, and Scl-70 antibody tests, were negative. Raynaud phenomenon was not seen. There was an absence of nailfold capillary changes and distal digital pitting.

The patient was treated with nonsteroidal anti-inflammatory drugs, systemic steroid therapy, and disease-modifying antirheumatic drugs (ie, hydroxychloroquine), but symptoms persisted. Two weeks after treatment initiation, multiple tender nodules developed over the palms and interphalangeal joints, and flexion contractures continued (Figure, A). Incisional skin biopsy of the palmar nodules (Figure, B and C) and computed tomography (CT) were performed. Results of the CT demonstrated bilateral ovarian tumors with highly suspect peritoneal metastases.

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