Paraneoplastic palmar fasciitis

A 50-year-old woman presented to our rheumatology clinic with a history of inability to extend her fingers for the past 7 months. Initially, she noticed stiffness and tightening of the fingers in her left hand which gradually grew worse till she could no longer extend her fingers. For the past 2 months, similar symptoms appeared in her right hand. There was no history of puffiness of the hands, Raynaud phenomenon or joint pain. Examination revealed fixed flexion deformities of the fingers with thickening of the palmar fascia and deepening of the palmar creases—the ‘groove sign’ [Figure - 1]. Radiographs of the hands were normal. Two years earlier, the patient had been diagnosed to have infiltrating ductal carcinoma of the left breast with metastatic deposits in the lumbar vertebrae. She was receiving palliative chemotherapy, but her local disease remained non-responsive.

Figure 1: Picture of the patient’s hands showing fixed flexion deformities of the fingers due to palmar fasciitis

Palmar fasciitis is a rare paraneoplastic manifestation most often associated with ovarian carcinoma.^[1] A few cases have also been reported in association with carcinoma breast.^[2] Differential diagnoses of this disorder include scleroderma, Dupuytren contracture and complex regional pain syndrome. There is no effective therapy; in some patients, partial or rarely total resolution has been reported following cure of the underlying malignancy.