Nigro A. Misdiagnosis of psoriatic arthritis in a patient with paronychia confirmed by dermatological examination: A case report. World J Clin Cases 2025; 13(18): 102194 [DOI: 10.12998/wjcc.v13.i18.102194]
Corresponding Author of This Article
Angelo Nigro, MD, Chief Physician, Department of Rheumatology of Lucania, UOSD of Rheumatology, "Madonna delle Grazie" Hospital, Via Cattedra Ambulante, Matera 75100, Basilicata, Italy. angelonigro13@gmail.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 26, 2025; 13(18): 102194 Published online Jun 26, 2025. doi: 10.12998/wjcc.v13.i18.102194
Misdiagnosis of psoriatic arthritis in a patient with paronychia confirmed by dermatological examination: A case report
Angelo Nigro
Angelo Nigro, Department of Rheumatology of Lucania, UOSD of Rheumatology, "Madonna delle Grazie" Hospital, Matera 75100, Basilicata, Italy
Author contributions: Nigro A is the sole author of this manuscript. He was responsible for the conception, design, analysis, and interpretation of the data. He also drafted and critically revised the manuscript, ensuring the accuracy and integrity of all aspects of the work.
Informed consent statement: Written informed consent was obtained from the patient (or their legal guardian, if applicable) for the publication of this case report, including all accompanying images and clinical information. Every effort was made to ensure the patient's anonymity and confidentiality.
Conflict-of-interest statement: The author, Angelo Nigro, declares no conflicts of interest related to the publication of this manuscript. No financial, personal, or professional relationships that could be perceived to influence the content of this work exist.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Angelo Nigro, MD, Chief Physician, Department of Rheumatology of Lucania, UOSD of Rheumatology, "Madonna delle Grazie" Hospital, Via Cattedra Ambulante, Matera 75100, Basilicata, Italy. angelonigro13@gmail.com
Received: October 11, 2024 Revised: December 11, 2024 Accepted: February 18, 2025 Published online: June 26, 2025 Processing time: 138 Days and 22.6 Hours
Abstract
BACKGROUND
This case highlights the importance of a multidisciplinary approach in differentiating localized infections from systemic inflammatory diseases like psoriatic arthritis. Nail psoriasis can mimic conditions like paronychia, complicating diagnosis. We wrote this report to emphasize the need for clinical vigilance when interpreting imaging findings, especially in patients with a family history of psoriasis. Misdiagnosis can lead to unnecessary systemic treatments, underscoring the significance of dermatological input in achieving accurate diagnoses.
CASE SUMMARY
A 56-year-old woman presented with redness and swelling of multiple fingertips. Her family history of psoriasis raised suspicion of psoriatic arthritis. Two rheumatologists diagnosed psoriatic arthritis based on ultrasound findings of enthesitis with a positive Doppler signal and recommended methotrexate. However, she was reluctant to initiate therapy due to potential side effects. At our Rheumatology Center, paronychia was suspected, and laboratory tests excluded systemic inflammatory arthritis. Dermatological examination confirmed paronychia, and treatment with fluconazole and ceftriaxone was initiated to address suspected mixed bacterial and fungal infections. Imaging studies, including hand and wrist X-rays, showed no erosions or other signs of psoriatic arthritis. The patient responded well to antimicrobial therapy, with resolution of symptoms. This case highlights the need for thorough clinical evaluation, careful interpretation of imaging findings, and collaboration between rheumatologists and dermatologists to avoid misdiagnosis and inappropriate treatment.
CONCLUSION
This case underscores the need for thorough clinical evaluation and caution in interpreting nonspecific imaging findings, especially in patients with a family history of psoriasis. While familial predisposition may raise suspicion for psoriatic arthritis, it is essential to integrate laboratory data, imaging studies, and clinical presentation, including response to targeted antimicrobial therapy. A multidisciplinary approach, involving both rheumatologists and dermatologists, is crucial to preventing misdiagnosis, ensuring appropriate treatment, and avoiding the potential harms of unwarranted therapies.
Core Tip: This case report emphasizes the importance of a multidisciplinary approach in distinguishing localized conditions, such as paronychia, from systemic inflammatory diseases like psoriatic arthritis. Misdiagnosis based on imaging findings, such as enthesitis with positive Doppler signal, can lead to unnecessary systemic treatments with potential adverse effects. A comprehensive clinical evaluation, including dermatological expertise, revealed paronychia as the underlying condition in a patient initially misdiagnosed with psoriatic arthritis. Timely antimicrobial therapy resolved the symptoms, highlighting the critical role of integrating clinical, imaging, and laboratory findings to avoid diagnostic errors and optimize patient outcomes.
