Pitting edema and hypertrophic pulmonary osteoarthropathy

To the Editor .—We report the case of a patient who presented with marked lower-extremity pitting edema as part of the syndrome of hypertrophic pulmonary osteoarthropathy (HPO). Report of a Case .—A 50-year-old man presented with right-arm numbness and he was found to have a right-sided Pancoast tumor. Six months before admission, the patient had noted the insidious onset of bilateral knee and ankle pain and stiffness plus lower-extremity edema. A diuretic had no effect, but naproxen provided gradual relief of symptoms and improvement in edema. The naproxen was discontinued on that admission; a week later, the patient again complained of bilateral knee and ankle pain, swelling, and edema. Small knee effusions were present, though there was no focal knee or ankle tenderness, and range of motion was preserved. Bilateral tender pitting edema to below the knees was noted. Abdominal and cardiac examinations were benign. Finger clubbing was present. Rheumatoid factor and