Case 1: A six-year-old boy with finger contractures.

Abstract

A six-year-old boy of Chinese descent presents with a six-month history of finger contractures of the right third and fourth digits. His teacher first noticed his inability to lay his right palm flat. There was no history of trauma or infection to the hand, and no other symptoms were present. The patient denied pain and swelling, and could perform regular activities without limitations. His medical history was negative, other than a possible peanut allergy. He had no history of oral ulcers, conjunctivitis or joint pain, and the remaining review of systems was unremarkable. Initial examination revealed a well-appearing boy with contractures of the right third and fourth metacarpal-phalangeal and proximal interphalangeal joints (Figure 1). In addition, his right fourth digit measured 0.2 cm shorter than the left. A 5 cm brown-coloured thickened lesion with a mild erythematous border was observed on the right palm. His left hand appeared normal and his general physical examination was otherwise normal. Figure 1) Finger contractures and thickened skin lesions in a six-year-old boy Laboratory investigations revealed normal complete blood count, electrolyte levels, liver enzyme levels and renal function. C-reactive protein level, erythrocyte sedimentation rate and complement level were normal. Rheumatoid factor and anti-nuclear antibody were negative. Several months later, a similar lesion appeared on the palmar side of his right wrist.