Abstract
BackgroundPrimary hypertrophic osteoarthropathy also known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features. Vascular endothelial growth factors which have been implicated in the clinical features of pachydermoperiostosis, have also been shown to be present in chronic hepatitis and implicated in the malignant transformation of hepatitis B infection to hepatocellular carcinoma. To the best of our knowledge there is one reported case of pachydermoperiostosis with chronic hepatitis B infection. We do not imply a causal relationship between pachydermoperiostosis and hepatitis B infection because pachydermoperiostosis is a genetic disorder; however, the question is raised whether hypertrophic osteoarthropathy is one of the many extrahepatic manifestations of chronic hepatitis B infection.Case presentationA 21-year-old African (Ghanaian) man with chronic hepatitis B infection was referred to our Endocrine unit as having acromegaly with changing facial features, enlarging hands and feet, and large knee joint effusions which affected activities of daily living. He was finally diagnosed as having pachydermoperiostosis when acromegaly, rheumatological disorders, as well as cardiopulmonary disorders were ruled out. He improved with arthrocentesis, a tapering regime of steroids, non-steroidal anti-inflammatory drugs, and proton pump inhibitors.ConclusionsThe possible role of hepatitis B in hypertrophic osteoarthropathy, that is, secondary hypertrophic osteoarthropathy, needs to be explored; however, with digital clubbing in his father our patient is likely to have pachydermoperiostosis.
Highlights
Primary hypertrophic osteoarthropathy known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features
We are not certain of the mechanisms underlying PDP, but there is some suggestion that fibroblast activation [5], vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) may have a role [6, 7]
It has been suggested that the virus may not be the sole causative agent for malignant transformation in hepatitis B infection but angiogenic factors similar to those in PDP play a role [9,10,11]; Atiase et al Journal of Medical Case Reports (2018) 12:59 hepatitis B is associated with many extrahepatic manifestations but it is not known whether hypertrophic osteoarthropathy is one of them, this needs further investigation and exploration
Summary
PDP is often investigated as acromegaly and is ruled out by normal biochemical and radiological investigations. We have suggested exploring the link between PDP and chronic hepatitis infection; with this patient’s father having digital clubbing we think this case is likely to be primary hypertrophic osteoarthropathy and not secondary hypertrophic osteoarthropathy from chronic hepatitis B infection. Patient’s perspective Our patient admits to feeling depressed occasionally because of the change in his physical appearance and because his family feels his condition is self-inflicted, as he has refused to seek alternative treatment. He has lost friends and has been unable to pursue his dream of being an accountant
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