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Subsequent investigation revealed occult fracture of the distal femur with joint effusion, secondary to isolated metastatic disease from recurrent small cell lung cancer. This case demonstrates the importance of reconsidering differential diagnoses when a patient\u2019s symptoms do not respond to appropriate treatment as expected. It also highlights the limitations of surveillance protocols and the influence that recent specialist input can have on diagnostic processes.<\/jats:p>","DOI":"10.1136\/bcr-2021-243382","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T12:19:34Z","timestamp":1629461974000},"page":"e243382","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["First recurrence of small cell lung cancer presenting as subacute monoarticular arthritis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3154-3609","authenticated-orcid":false,"given":"John Peter","family":"McCormick","sequence":"first","affiliation":[{"name":"Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland"},{"name":"Cardiology, St James's Hospital, Dublin, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Trueick","sequence":"additional","affiliation":[{"name":"Medical Oncology, Tullamore General Hospital, Tullamore, Offaly, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Connaughton","sequence":"additional","affiliation":[{"name":"Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niamh","family":"McDonnell","sequence":"additional","affiliation":[{"name":"Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2025082623483444000_14.8.e243382.1","first-page":"810","article-title":"Acute monoarthritis: diagnosis in adults","volume":"94","author":"Becker","year":"2016","journal-title":"Am Fam Physician"},{"key":"2025082623483444000_14.8.e243382.2","doi-asserted-by":"crossref","first-page":"vi99","DOI":"10.1093\/annonc\/mdt178","article-title":"Small-Cell lung cancer (SCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"24 Suppl 6","author":"Fr\u00fch","year":"2013","journal-title":"Ann Oncol"},{"key":"2025082623483444000_14.8.e243382.3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.lungcan.2014.08.022","article-title":"Bone metastasis, skeletal-related events, and mortality in lung cancer patients: a Danish population-based cohort study","volume":"86","author":"Cetin","year":"2014","journal-title":"Lung Cancer"},{"key":"2025082623483444000_14.8.e243382.4","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000051"},{"key":"2025082623483444000_14.8.e243382.5","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.7150\/jca.16211","article-title":"Incidence and predictors of bone metastases (BM) and skeletal-related events (SREs) in small cell lung cancer (SCLC): a Swiss patient cohort","volume":"7","author":"Conen","year":"2016","journal-title":"J Cancer"},{"key":"2025082623483444000_14.8.e243382.6","doi-asserted-by":"publisher","DOI":"10.7150\/jca.30463"},{"key":"2025082623483444000_14.8.e243382.7","first-page":"98","article-title":"Metastatic carcinomatous arthritis and carcinoma of the lung. 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