Mechanic's Hands Imitating Hand Eczema.

摘要

Skin symptoms can be a diagnostic clue to a systemic disease. "Mechanic's hands" refers to characteristic hyperkeratotic lesions on the hands, part of the anti-synthetase syndrome with antibodies against histidyl-tRNA synthetase (anti-Jol antibodies). We present a patient with mechanic's hands that imitate hand eczema. A 67-year-old woman was referred because of presumed hand eczema. She complained of roughness and cracking of the skin on several fingers, symptoms that did not respond to treatment with topical corticosteroids and moisturizers. For 1 year, she had suffered from general fatigue, intermittent fever, widespread arthralgias, and tenosynovitis. Additionally, she had persistent pulmonary symptoms with cough and dyspnea. High-resolution computed tomography and positron emission tomography showed diffuse interstitial infiltrates, but biopsy specimens from the lung and mediastinal lymph nodes were without signs of malignancy or specific inflammatory disease. Liver, bone marrow, and salivary gland biopsy specimens were normal, and the results of abdominal and gynecologic examinations were normal. Blood samples showed elevated C-reactive protein, erythrocyte sedimentation rate, creati-nine kinase 301 U/L (35-200 U/L), and positive Ro/SSA autoantibodies, but normal antinuclear antibodies (ANAs), antineutrophil cytoplasmic autoantibodies (ANCAs), rheumatoid factor, cryoglobulin, and Borrelia and scleroderma antibodies.