The many symptoms of pachydermoperiostosis.

A 26-year-old black man with a 3-year history of persistent joint pain and swelling of the wrists and ankles and enlargement of his hands and feet, also reported ‘deformity’ of his fingernails (clubbing) since childhood. His father had similar symptoms, but no siblings were affected. The subject had marked soft-tissue enlargement of the hands and feet and gross clubbing with increased curvature of the nail angle (Lovibond’s angle), bogginess of the nailbed and typical ‘drumsticking’ (Fig. 1). There was bony overgrowth and tenderness at the wrists and ankles with marked limitation of movement, and hyperhidrosis of the face, hands and feet was noted. No other physical signs or abnormal biochemistry were noted.