A 76-Year-Old Man With a Five-Day History of Painful Swelling of the Right Hand

Abstract

History A 76-year-old man had a five-day history of painful swelling of the right hand. During the past four years, he had had similar episodes responding to short-term indomethacin (Indocin) therapy. On admission, his temperature was 37.9 °C. His right hand was swollen, erythematous, and tender, with pitting edema of the dorsum of the hand and sausage-shaped digits. The right elbow demonstrated decreased motion, with tenderness and erythema around the lateral epicondyle. (The results of relevant laboratory studies are withheld.) Radiological studies of the right hand and wrist were obtained (Figs 1 and 2). These demonstrated periarticular calcifications around the second, third, and fourth metacarpophalangeal joints, linear calcification between the radius and scaphoid and radius and lunate, and dense punctate calcification in the triangular fibrocartilage (between the ulnar styloid process and the distal radioulnar articulation) (Fig 1). The right elbow showed periarticular calcification and calcification in the hyaline cartilage of