Painless swelling of proximal interphalangeal joints in an adolescent child with preserved function and normal acute phase reactants

摘要

A previously healthy 12-year-old male patient presented with one-year history of bilateral (left more than right) swelling of the proximal interphalangeal (PIP) joints (Figure 1). The patient denied any tenderness with movement, nocturnal pain, or morning stiffness. The only findings on physical examination were swelling of the PIPs of the fingers. Laboratory investigations including complete blood count with differentials, erythrocyte sedimentation rate, rheumatoid factor, and antinuclear antibodies were normal. Hand radiographs revealed nonspecific swelling of the volar soft tissues abutting the distal metaphysis of the proximal phalanges of the second to fifth fingers (Figure 2). The patient was diagnosed with Thiemann’s disease (Online Mendelian Inheritance in Man: 165700).