Bisphosphonates use in a Case of Pachydermoperiostosis

Case Report

Austin J Orthopade & Rheumatol. 2017; 4(1): 1046.

Bisphosphonates use in a Case of Pachydermoperiostosis

Jagdish RK¹*, Bhatnagar MK¹, Malhotra A¹, Aggarwal R¹ and Shailly²

¹Santosh Medical College & Hospital, Santosh University, Ghaziabad, India

²Chest and TB Hospital, Govt. Medical College, Patiala, India

*Corresponding author: Rakesh Kumar Jagdish, Department of Rheumatology Clinic, Santosh Medical College & Hospital, Santosh University, Ghaziabad, India

Received: January 05, 2017; Accepted: February 07, 2017; Published: February 09, 2017


Pachydermoperiostosis is a rare Autosomal disorder, which commonly presents with clubbing, bone pains and skin changes. The treatment is unsatisfactory. We tried bisphosphonates in its treatment with encouraging results. We suggest that injectable bisphosphonates should be tried early in treatment of Pachydermoperiostosis.

Keywords: Pachydermoperiostosis; Primary osteoarthropathy; Touraine- Solente-Gole´ syndrome; Treatment; HOAP (Hypertrophic Osteoarthropathy); Bisphosphonates


Pachydermoperiostosis, also known as Touraine-Solente-Gole´ syndrome, primary or idiopathic Hypertrophic Osteoarthropathy (HOAP). It is a rare autosomal disorder with variable expression. Pachydermoperiostosis is characterized by bilateral and symmetrical grade IV clubbing, periosteal new bone formation, thickening of skin (pachyderma) and excessive sweating (hyperhydrosis). No treatment is curative, symptomatic treatment such as NSAIDS, Steroids, colchicines are used. There are case reports of bisphosphonates use with good results in secondary HOAP [1,2]. The uses of bisphosphonates in primary HOAP/Pachydermoperiostosis are only few [3].

Case Presentation

A 31 years old, male patient, non smoker, non alcoholic, resident of Bihar, presented to us with history of pain and swelling in hands and feet, followed by involvement of ankle, knee and wrist joints, of 15 years duration, this was associated with hyperhydrosis of palms and soles. There was no history of fever, palpitation, bluish discolouration, backache, haemoptysis, haemetemesis, hematuria, haematochezia, cough, expectorations, dyspnea, oral ulcers, weight loss and bleeding tendency. Family history of similar complains positive in paternal cousin brother.

On physical Examination, He was a febrile, Pulse-70/min, Respiratory rate-16/min, BP-122/80 mmHg, SpO2-98% at room air, there was no cyanosis, pallor, lymphadenopathy and oedema. On systemic examination-respiratory, cardiovascular, abdominal and neurological examination were normal, on skin examination there was furrowing on the forehead, skin is oily and shiny in appearance (Figure 1), Hyperhydrosis of hands and feet. Musculoskeletal examination shows-grade IV clubbing along with widening of wrist and ankle joint, swelling of both the knee joint (Figures 3-6).