Hypertrophic osteoarthropathy as a complication of pulmonary tuberculosis

Abstract

The patient is a 17-year-old man with a history of pulmonary tuberculosis treated for 6 months with the standard regimen [isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months (intensive phase) followed by isoniazid and rifampin for 4 months (continuation phase)] with complete adherence and whose sputum smears at the end of his treatment were negative for acid-fast bacillus. Six months later, he presented to the emergency room complaining of pain and swelling of the ankles, knees and wrists for four weeks prior to admission with no constitutional (fever, night sweats, fatigue, weight loss) and respiratory symptoms. On physical examination, finger clubbing was evident and confirmed by observation of the Schamroth’s sign (Fig. 1). Chest computer tomography showed cystic bronchiectasis and cavitations in the left lower and upper lobes (Fig. 2). X-rays of wrists and legs showed periosteal reaction along the metacarpals, distal radius, ulna, tibia and fibula (Fig. 3) but not acro-osteolysis of the distal phalanges of the hands and feet. Human immunodeficiency virus antibody test was negative. Pharmacologic therapy with nonsteroidal anti-inflammatory drugs was effective in relieving pain from hypertrophic osteoarthropathy (HOA) during his hospital stay and after 3 months of follow-up.