A case of severe arthralgia with malignant mesothelioma-associated hypertrophic osteoarthropathy

Our plain-English summary of A case of severe arthralgia with malignant mesothelioma-associated hypertrophic osteoarthropathy, by H. Yamakawa, A. Sekine, T. Kato, et al (Clinical Case Reports, 2016).

The study

• Authors: H. Yamakawa, A. Sekine, T. Kato, Y. Yamanaka, E. Hagiwara, S. Umeda, T. Ogura
• Journal: Clinical Case Reports
• Published: 2016;4(11):1057-1060
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Hypertrophic osteoarthropathy (HOA) is a rare syndrome characterized by the abnormal proliferation of dermato-osseous tissue. We report a rare case of malignant mesothelioma-associated HOA who suffered from refractory painful osteoarthropathy. HOA can be associated with malignant mesothelioma and that may be resistant to any treatment.

In plain English

This case report from Japan described one patient: a 67-year-old man, a current smoker, exposed to asbestos during 4 years' work as a miner in his twenties. The fiber type was not stated. Repeated antibiotic treatment for suspected bacterial pleurisy failed. A biopsy then confirmed epithelioid-type malignant pleural mesothelioma. He had clubbing of the fingers and painful joints, and a bone scan showed uptake in the wrists, shoulders and knees. The authors judged these findings consistent with hypertrophic osteoarthropathy (HOA), a condition affecting skin and bone, secondary to the mesothelioma. His blood growth hormone (1.91 ng/mL) and vascular endothelial growth factor (411 pg/mL) were raised. Chemotherapy with cisplatin and pemetrexed shrank the tumor and lowered growth hormone. His joint pain and fever did not improve with anti-inflammatory drugs, and steroids helped only slightly and briefly. He died 9 months after diagnosis. The authors concluded that his condition was hard to explain solely by growth hormone or vascular endothelial growth factor. They also concluded that asbestos workers who develop joint pain or finger clubbing should be carefully examined for mesothelioma-associated HOA.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 67-year-old man, a current smoker (0.5 pack/day for 40 years), referred to the Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
• Exposure: History of asbestos exposure from 4 years' employment as a miner in his twenties; fiber type not stated
• Main results:
  • Thoracoscopic pleural biopsy with immunohistochemistry confirmed epithelioid-type malignant pleural mesothelioma in this patient
  • Finger clubbing, joint pain and bone scintigraphy findings in the patient were judged consistent with secondary HOA of malignant mesothelioma
  • The patient's serum growth hormone was elevated at 1.91 ng/mL and serum VEGF at 411 pg/mL; tumor cells stained positive for VEGF
  • After one cycle of cisplatin and pemetrexed, the patient's serum growth hormone fell to 0.6 ng/mL, but arthralgia and fever did not improve with NSAIDs
  • Oral betamethasone (2 mg/day) gave only slight temporary improvement; arthralgia and fever worsened when the dose was reduced
  • After four cycles the mesothelioma had shrunk and disease was considered stable, with growth hormone reported as 0.17 mg/mL (unit as printed); arthralgia and fever continued
  • The patient was transferred for palliative care and died 9 months after diagnosis
• The authors' conclusion: The authors concluded that the syndrome in this case was difficult to explain solely by growth hormone or VEGF. They also concluded that careful examination for malignant mesothelioma-associated HOA should be undertaken if arthralgia and/or digital clubbing develops in asbestos workers.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Hypertrophic osteoarthropathy in childhood malignancy — C.R. Staalman, U. Umans (1993)
• Secondary hypertrophic osteoarthropathy caused by non-pleural or pulmonary tumors — H.J. Meyer, L. Leifels, et al. (2017)
• Hypertrophic Pulmonary Osteoarthropathy as an Initial Manifestation of Lung Cancer — S.K. Mohamed Ahmed, Y.K. Mohamedahmed, et al. (2025)
• Large pericardial mesothelial cyst coexisting with hypertrophic obstructive cardiomyopathy — A. Sadeghpour, A. Alizadeh-Ghavidel, et al. (2020)
• Unexpected complication of successful nerve block. Morphine induced respiratory depression precipitated by removal of severe pain — G.W. Hanks, R.G. Twycross, et al. (1981)
• A MUC5B Gene Polymorphism, rs35705950-T, Confers Protective Effects Against COVID-19 Hospitalization but Not Severe Disease or Mortality — A. Verma, J. Minnier, et al. (2022)

Browse more research in Clinical Case Reports, or return to medical research.