‘Sausage finger’ without bone involvement

Abstract

A 58-year-old man presented with a history coughing and expectoration. He also reported dyspnoea, chest pain, weight loss, exhaustion, joint pain and swelling. The dyspnoea had been the first respiratory symptom to arise, which had started 6 months before presentation, and the first nonrespiratory symptom was weight loss, which started 4 months before presentation. The patient had no history of tuberculosis, and he did not smoke or consume alcohol. Chest radiography and computed tomography of the thorax revealed bilateral hilar and mediastinal lymph nodes and nodular lesions. A fibre-optic bronchoscopy did not show any abnormalities. Pulmonary function tests were consistent with a restrictive lung disease. There was no evident involvement of the peripheral lymph nodes, upper respiratory system, eyes, bones or joints. Bronchoalveolar lavage was negative for acidresistant bacilli. Angiotensin I-converting enzyme (ACE) was 73 U ⁄ L (normal range 8.3–21.4). An X-ray of the second finger of left hand showed oedema surrounding the soft tissue and no osseous abnormalities (Fig. 1a), and the patient was referred to the dermatology department On physical examination, swelling of the left index finger, from the metacarpophalangeal joint to the fingertip, was noted (Fig. 1b), giving a ‘sausage finger’ appearance. No other abnormalities were found. A punch biopsy was taken from the extensor part of left index finger.