de Boer Anouk G, Klaasen Ruth, van der Goes Marlies C, Bloemendal Haiko J
Department of Internal Medicine, Meander Medisch Centrum, Amersfoort, Netherlands.
Department of Rheumatology, Meander Medisch Centrum, Amersfoort, Netherlands.
J Med Cases. 2020 Sep;11(9):267-270. doi: 10.14740/jmc3522. Epub 2020 Aug 6.
A 73-year-old patient was seen in our hospital for treatment of metastatic adenocarcinoma of the prostate (pTNM R, gene mutation). Prostatectomy and regional radiotherapy were performed and goserelin, a luteinizing hormone-releasing hormone (LHRH) analog, had been started because of disease progression. Castration-resistant progressive disease developed, and enzalutamide was added. A decrease of the prostate-specific antigen (PSA) level was achieved. Before the start of enzalutamide, the patient developed bilateral pain and stiffness of both hands combined with thickening of the hands. The symptoms progressed rapidly to bilateral flexion and extension contractures. The patient became unable to tie his shoelaces and had to use adjusted cutlery to eat. Consultation of the rheumatologist, X-rays, ultrasound and palmar skin biopsy of the hands were performed. The clinical picture resembles descriptions of "palmar fasciitis and polyarthritis syndrome" (PFPAS), a rare paraneoplastic syndrome. Positive effects of immunosuppressive medication have been reported in some cases. In our patient, treatment with oral prednisone (30 mg daily) showed no effect, therefore treatment was switched to methylprednisone pulses and methotrexate. PFPAS is an uncommon paraneoplastic syndrome characterized by rapid onset of bilateral arthritis of the hands, fasciitis of the palms, progressive stiffness and contractures. The scarcity of knowledge about PFPAS makes it difficult to recognize it at an early stage. As a paraneoplastic syndrome, it has been linked to various malignancies. Thus far, PFPAS has been described in only two other cases of prostate cancer.
一名73岁的患者因前列腺转移性腺癌（pTNM R，基因突变）前来我院治疗。已进行前列腺切除术和局部放疗，由于疾病进展，已开始使用促性腺激素释放激素（LHRH）类似物戈舍瑞林。出现去势抵抗性进展性疾病后，加用了恩杂鲁胺。前列腺特异性抗原（PSA）水平有所下降。在开始使用恩杂鲁胺之前，患者出现双手双侧疼痛和僵硬，并伴有手部增厚。症状迅速发展为双侧屈伸挛缩。患者无法系鞋带，不得不使用经过调整的餐具进食。咨询了风湿病专家，对手部进行了X线、超声检查和手掌皮肤活检。临床表现类似于“掌腱膜炎和多关节炎综合征”（PFPAS）的描述，这是一种罕见的副肿瘤综合征。在一些病例中，免疫抑制药物已被报道有积极效果。在我们的患者中，口服泼尼松（每日30毫克）治疗无效，因此将治疗改为甲泼尼龙冲击疗法和甲氨蝶呤。PFPAS是一种罕见的副肿瘤综合征，其特征是双手双侧关节炎、手掌腱膜炎迅速发作，伴有进行性僵硬和挛缩。对PFPAS的了解匮乏使得早期识别它很困难。作为一种副肿瘤综合征，它与多种恶性肿瘤有关。迄今为止，仅在另外两例前列腺癌病例中描述过PFPAS。
