[Pleomorphic carcinoma of the lung heralded as bilateral leg pain]

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.