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Acrometastasis: First Metatarsophalangeal Joint Pain Due to Metastatic Lung Cancer: A Case Report.

Cancer metastasis is the most common malignant neoplasm of bone in adults, accounting for about 20% to 30% of patients with metastatic disease1,2. Metastatic disease of the hand or foot (acrometastasis) is rare, occurring in only 0.007% to 0.3% of cancer patients1; acrometastasis to only the bones of the foot accounts for 33% to 50% of these cases3. Acrometastases are generally late manifestations of occult cancer and are associated with a poor prognosis. The tumors that have predilection for the hands and feet are from the lung, breast, and kidney. Although acrometastasis is rare, a high clinical suspicion must exist in evaluating a patient with a known history of cancer4. Many authors report that acrometastasis has been mistakenly identified as infection, osteomyelitis, gout, rheumatoid arthritis, Reiter syndrome, Paget disease, reflex sympathetic dystrophy, and ligamentous strain5-7. Consequently, symptoms are overlooked or misdiagnosed, resulting in delayed or inappropriate treatment. Early diagnosis and treatment are important for improving the quality of life of these patients.

This case report describes a patient with a known history of cancer whose treatment of acrometastasis was not started for months because of a delayed diagnosis. The patient was informed that the details of the case would be prepared for publication, and he provided consent.

A sixty-seven-year-old man with a medical history of non-small-cell lung cancer treated with surgical resection and radiation therapy, chronic anemia, type-2 diabetes mellitus, hyperlipidemia, hypertension, aortic stenosis, and gout presented to his primary care provider with right foot …