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Concurrent Hypertrophic Osteoarthropathy and Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis in a Patient
Isaac K S Ng1,2, Kaung Myat3, Salil B Singbal3
1Division of Rheumatology and Allergy, Department of Medicine, National University Hospital, Singapore.
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Hypertrophic osteoarthropathy (HOA) is a prototypical paraneoplastic arthritis associated with lung cancer, specifically NSCLC. With the increasing use of immune checkpoint inhibitors (ICIs), ICI-induced inflammatory arthritis (IA) is another important differential diagnosis for joint pain in patients with lung cancer. We report, to our knowledge, the first case of a patient with stage 4 lung adenocarcinoma and paraneoplastic HOA who subsequently developed ICI-IA and cytokine release syndrome while receiving the PD-1 inhibitor, pembrolizumab. Differentiating between HOA and ICI-IA is essential because of their differing treatment implications, requiring careful clinical assessment with adjunctive biochemical (including cytokine profiling), radiological, and synovial fluid investigations.
