Pachydermodactyly: bilateral proximal interphalangeal joint swelling in an adolescent musician

An otherwise healthy young man was referred to the rheumatologist because of bilateral proximal interphalangeal (PIP) joint enlargements. The main concern was excluding the presence of inflammatory arthritis. Physical examination revealed bilateral PIP finger joints (II-IV) swellings and cutaneous thickenings in adjacent areas. The specificity of this case was the patient who appeared in the physician's room with his violin suitcase pointing to his profession even from the first site. Complete blood count with leucocyte differentials appeared without changes. Radiographics failed to show joint fluid or bony changes. All immunological markers (RF, anti-cyclic citrullinated peptide) and laboratory data (Erythrocyte sedimentation rate, C-reactive protein, etc) were within the reference ranges or negative. After exclusion of rheumatoid and other inflammatory arthritis, and considering the occupation of the patient and demographics the diagnosis of a rare condition-pachydermodactyly was made.