Bilateral puffy hands are a tip-off of a diagnosis that is growing in prevalence and in importance to rheumatology. What should they call to mind?
This patient's “puffy hands” began as pitting and edema, followed by thickening and fibrosis of the subcutaneous tissue.
We have omitted another fact crucial to this diagnosis: The patient is a former heroin addict. The resulting isolated hand edema is often called "hep C hands". HCV infection has the highest incidence in persons born between the 1940s and the 1960s, and the prevalence of symptomatic HCV infection is increasing as the disease is becoming more apparent in the aging baby boomer generation. The "maturing process" of this population segment, dating back to the 1960s and 1970s, included widespread experimentation with drugs that ranged from LSD and other hallucinogens to hardcore intravenous (IV) heroin use. The latter resulted in repeated exposure to HCV infection (and subsequent development of chronic liver disease as well as rheumatologic disorders). Hepatitis C is an essential diagnosis to consider in such patients who have unilateral or bilateral puffy hands.
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