Pleomorphic Carcinoma of the Lung Heralded as Bilateral Leg Pain
George Habib, Hanna Rawashdi, Jonathan Peleg, Walid Saliba
Depts. of Medicine B, Neurology and Radiology, Lady Davis Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
This is a case of a 70 year old male patient suffering from bilateral leg pain for 2 months. Physical examination disclosed clubbing. X-rays of the legs showed bilateral periosteal elevation with subperiosteal bone formation. 99TM-diphosphonate bone scan was negative. A search for malignancy revealed pleomorphic carcinoma of the right lung. Pain symptom disappeared 2 days after resection of the tumor. Repeated X-rays of the legs, three and a half months later showed no change and the clubbing persisted.
Hence, unexplained bilateral leg pain should raise suspicion of hypertrophic osteoarthropathy, and elicit a search for secondary disease especially lung tumor. It is interesting to point out the negative bone scan and the rapid resolution of patient symptoms after resection of the tumor.