Hypertrophic osteoarthropathy in childhood Hodgkin's disease.


The patient, a 15-year-old boy, presented with fever, dry cough, and polyarthritis involving the wrists, elbows, ankles, and knees bilaterally. Examination revealed pallor, clubbing, and generalized tenderness over the long bones and generalized lymphadenopathy (axillary, supraclavicular, and cervical groups). Radiographs of the forearms revealed a striking periosteal reaction (arrows in A), indicative of hypertrophic osteoarthropathy (HOA), and a chest radiograph showed right lower zone opacity. A contrast-enhanced computed tomography scan of the chest revealed enlarged pretracheal, right paratracheal, right hilar, subcarinal, and azygoesophageal nodes (black arrow in B), with compression of the right lower lobe bronchi and right lower lobe collapse (white arrow in B). A biopsy of a supraclavicular lymph node revealed Hodgkin's disease of mixed cellularity type. HOA is seldom observed in children and, if present, is usually secondary to chronic suppurative lung disease or congenital heart disease. Malignancy as a cause of HOA in children is very rare. In a literature search spanning 100 years from 1890 to 1990, only 24 cases were reported, of which only 3 were secondary to Hodgkin's disease (1). There have been only 2 more reported cases of HOA and Hodgkin's disease to date (2). HOA may precede malignancy by 1–18 months and may be reversed with therapy.1

Illustration 1.