case_images: PMC10474806_01
case_images: A) marked furrowing of the forehead and thickening of the skin; B) digital clubbing and swelling of the wrists and hands
case_images: PAMJ-45-88-g001.jpg
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case_images: F1
case_images: Clinical findings: the patient had deep grooves in his forehead and severe bilateral ptosis (Figure 1 A). He also had digital clubbing and swollen joints involving the wrists (Figure 1 B), knees, and ankles bilaterally were present.
case_images: A, B, C) X-rays of both hands and wrists showing increased bone density and loss of corticomedullary differentiation, medullary expansion, and irregular periosteal reaction (spiculated), narrowing of joint spaces at radiocarpal joints associated with diffuse soft tissue swelling; D, E, F) X-rays of his knees showing spiculation around the patellae and proximal tibiae, with thickened cortex with medullary expansion; G) spinal X-ray showing increased bone density with mild degeneration of the spines with anterior osteophytes at L2-L5 and loss of lumbar lordosis
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case_images: PMC10474806_01_PAMJ-45-88-g002.jpg
case_images: F2
case_images: Joint space narrowing was also seen at the radiocarpal and midcarpal joints (Figure 2 (A,B,C)). X-ray of his knees showed spiculated periosteal reaction around the patellae and proximal tibiae, thickened cortex, medullary expansion, and diffuse surrounding soft tissue swelling (Figure 2 (D,E,F)). Spinal X-rays showed increased bone density with mild degeneration to the lower lumbar spine (Figure 2G).
case_images: A) 20 mm full-thickness skin biopsy; B) cross-section of full-thickness right upper eyelid biopsy showing the thickened tarsal plate; C) right ptosis repair
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case_images: F3
case_images: Therapeutic intervention: he underwent right full-thickness wedge excision of the right upper eyelid (~ 20 mm with skin tissue biopsy) and levator muscle repair (Figure 3 (A,B,C)).
case_images: histopathological features A) low power; B,C) medium power; D) high power
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case_images: F4
case_images: Histology revealed sebaceous gland hyperplasia and prominent apocrine glands with mild hyalinization of the dermal collagen (Figure 4 (A,B,C,D)).
case_images: A) pre-ptosis repair; B) 2 weeks post right ptosis repair showing improvement of the right upper lid, allowing him to see through his visual axis
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case_images: PMC10474806_01_PAMJ-45-88-g005.jpg
case_images: F5