Paraneoplastic polyarthritis in an ovarian teratoma

A 34-year-old woman presented to the rheumatology clinic with severe low back pain and arthralgia; later she developed bilateral knee pain and swelling, with limitation in ambulation and minimal improvement with nonsteroidal antiinflammatory drugs. Two weeks later she developed pain on the volar aspect of the right wrist and on the hypothenar region of the right hand. Examination showed swelling and tenderness of the right hypothenar region, tenderness and decreased flexion and extension of the right wrist, and bilateral knee effusions. The combination of arthritis and tenosynovitis raised the possibility of an ovarian tumor. A pelvic ultrasound revealed a complex, hyperechoic ovarian mass consistent with a cystic teratoma. Four weeks after removal of the teratoma, the polyarthritis and related symptoms resolved without therapy.