[Skip to Navigation]
Views 2,074
Citations 0
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.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words