Breast cancer presenting as periostitis

A previously healthy 69-year-old woman presented with progressive and unremitting distal leg pain that was confirmed by biopsy to be periostitis. Ten months after the onset of symptoms, carcinoma of the breast was diagnosed. Surgical removal of the neoplasm was followed by complete relief of leg pain within 24 hours. Hypertrophic osteoarthropathy must be considered in adult patients presenting with unexplained joint or distal extremity symptoms, and a vigilant search for underlying malignancy should be undertaken.