{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:04:40Z","timestamp":1780635880305,"version":"3.54.1"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Pachydermodactyly (PDD) is a benign, non-inflammatory, non-erosive digital fibromatosis characterized by progressive, asymptomatic, periarticular soft tissue thickening predominantly affecting the proximal interphalangeal (PIP) joints. Additional localizations, including the palm and the distal interphalangeal (DIP) or metacarpophalangeal (MCP) joints, have also been reported. The etiology of PDD is multifactorial, encompassing idiopathic, trauma-induced, genetic, and behavioral factors. Objective: The aim of this report is to describe the clinical, imaging, and laboratory features of pachydermodactyly in two male adolescents initially referred to a pediatric rheumatology service for suspected juvenile idiopathic arthritis (JIA), highlighting the diagnostic pitfalls and differentiation criteria from inflammatory arthritis. In addition, a narrative review of cases published from 1975 to 2025 is presented to contextualize our findings within the broader literature. Results: Two male adolescents (aged 13 years and 5 months and 16 years) presented with progressive, painless periarticular soft tissue swelling of the PIP joints, initially raising suspicion for JIA. Comprehensive evaluation identified characteristic features of PDD in both patients, with complete absence of inflammatory markers, synovitis, or osseous changes. Case 1 was classified as mono-PDD and Case 2 as classic, trauma-associated PDD with atypical perilesional hypopigmentation, requiring MRI for definitive exclusion of infiltrative pathology. A narrative review of 15 representative published cases from 2014 to 2025 is presented, demonstrating persistent underdiagnosis and consistent misclassification as JIA across multiple clinical settings and geographic regions. Conclusions: PDD should be considered in the differential diagnosis of any adolescent presenting with painless digital swelling. Its recognition as a benign, non-inflammatory entity is essential to prevent unnecessary diagnostic procedures and immunosuppressive therapy. Clinical awareness and multidisciplinary assessment remain the cornerstones of accurate diagnosis and appropriate management.<\/jats:p>","DOI":"10.3390\/children13060748","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:36:56Z","timestamp":1779892616000},"page":"748","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pachydermodactyly: A Diagnostic Pitfall in Adolescents Referred to Pediatric Rheumatology for Suspected Juvenile Idiopathic Arthritis"],"prefix":"10.3390","volume":"13","author":[{"given":"Andrei-Ioan","family":"Munteanu","sequence":"first","affiliation":[{"name":"Department XI Pediatrics, Discipline I Pediatrics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"},{"name":"1st Department of Pediatrics, Children\u2019s Emergency Hospital \u2018Louis \u021aurcanu\u2019, 300011 Timisoara, Romania"},{"name":"Research Center for Disturbances of Growth and Development in Children BELIVE, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6064-2282","authenticated-orcid":false,"given":"Delia-Maria","family":"Nicoar\u0103","sequence":"additional","affiliation":[{"name":"Department XI Pediatrics, Discipline I Pediatrics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"},{"name":"1st Department of Pediatrics, Children\u2019s Emergency Hospital \u2018Louis \u021aurcanu\u2019, 300011 Timisoara, Romania"},{"name":"Research Center for Disturbances of Growth and Development in Children BELIVE, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6879-145X","authenticated-orcid":false,"given":"Iulius","family":"Jug\u0103naru","sequence":"additional","affiliation":[{"name":"Department XI Pediatrics, Discipline I Pediatrics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"},{"name":"1st Department of Pediatrics, Children\u2019s Emergency Hospital \u2018Louis \u021aurcanu\u2019, 300011 Timisoara, Romania"},{"name":"Research Center for Disturbances of Growth and Development in Children BELIVE, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6574-202X","authenticated-orcid":false,"given":"Raluca","family":"Asproniu","sequence":"additional","affiliation":[{"name":"Department XI Pediatrics, Discipline I Pediatrics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"},{"name":"1st Department of Pediatrics, Children\u2019s Emergency Hospital \u2018Louis \u021aurcanu\u2019, 300011 Timisoara, Romania"},{"name":"Ph.D. School Department, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-7643","authenticated-orcid":false,"given":"Otilia","family":"M\u0103rginean","sequence":"additional","affiliation":[{"name":"Department XI Pediatrics, Discipline I Pediatrics, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"},{"name":"1st Department of Pediatrics, Children\u2019s Emergency Hospital \u2018Louis \u021aurcanu\u2019, 300011 Timisoara, Romania"},{"name":"Research Center for Disturbances of Growth and Development in Children BELIVE, \u2018Victor Babe\u0219\u2019 University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.31138\/mjr.27.1.32","article-title":"Pachydermodactyly\u2014Symmetric soft tissue swelling around proximal interphalangeal joints may be misdiagnosed for arthritis","volume":"27","author":"Georgiou","year":"2016","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e28663","DOI":"10.1097\/MD.0000000000028663","article-title":"Unilateral pachydermodactyly misdiagnosed as juvenile idiopathic arthritis: A case report","volume":"101","author":"Aljohani","year":"2022","journal-title":"Medicine"},{"key":"ref_3","first-page":"455","article-title":"Pachydermie digitale des pre-mieres phalanges par hyperplasie conjonctive dermique et aplasia hypodermique","volume":"80","author":"Basex","year":"1973","journal-title":"Bull. Soc. Fr. Dermatol. Syphiligr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"136","DOI":"10.5114\/reum.2016.61215","article-title":"Pachydermodactyly\u2014A report of two cases","volume":"54","author":"Dyduch","year":"2016","journal-title":"Reumatologia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1093\/rheumatology\/keab453","article-title":"Pachydermodactyly in an adolescent boy: Is it more common than we think?","volume":"61","author":"Bocutcu","year":"2022","journal-title":"Rheumatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s11926-014-0442-7","article-title":"Pachydermodactyly: A review","volume":"16","author":"Dallos","year":"2014","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_7","first-page":"e41923","article-title":"Pachydermodactyly: Soft tissue enlargement of the fingers in a teenager","volume":"15","year":"2023","journal-title":"Cureus"},{"key":"ref_8","first-page":"703","article-title":"Pachydermodactyly: The role of ultrasonography and dermoscopy for diagnosis","volume":"56","author":"Zabotti","year":"2017","journal-title":"Rheumatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e923344","DOI":"10.12659\/AJCR.923344","article-title":"Pachydermodactyly: A case report of a little-known and benign form of digital fibromatosis","volume":"21","author":"Liew","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"328","DOI":"10.5152\/TurkArchPediatr.2024.23299","article-title":"Successful resolution of pachydermodactyly in an adolescent boy","volume":"59","author":"Koyuncu","year":"2024","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4103\/injr.injr_114_18","article-title":"Pachydermodactyly","volume":"13","author":"Sharma","year":"2018","journal-title":"Indian J. Rheumatol."},{"key":"ref_12","first-page":"247","article-title":"Pachydermodactylie: 7 nouveaux cas [Pachydermodactyly: Seven new cases]","volume":"125","author":"Bardazzi","year":"1998","journal-title":"Ann. Dermatol. Venereol."},{"key":"ref_13","first-page":"2239","article-title":"Magnetic resonance imaging in pachydermodactyly","volume":"32","author":"Anandacoomarasamy","year":"2005","journal-title":"J. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3325\/cmj.2022.66.164","article-title":"Pachydermodactyly\u2014The great imitator of arthritis: A case series","volume":"66","author":"Rukavina","year":"2025","journal-title":"Croat. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s11845-020-02378-1","article-title":"Pachydermodactyly: A systematic review","volume":"190","year":"2021","journal-title":"Ir. J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5152\/eurjrheum.2018.18079","article-title":"Swollen digits due to pachydermodactyly resembling inflammatory arthritis","volume":"6","author":"Acar","year":"2019","journal-title":"Eur. J. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102871","DOI":"10.1016\/j.amsu.2021.102871","article-title":"Painful pachydermodactyly in a 39-year-old woman: A case report and review of the literature","volume":"70","author":"Hussain","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e237214","DOI":"10.1136\/bcr-2020-237214","article-title":"Pachydermodactyly presenting as juvenile idiopathic arthritis in an adolescent man","volume":"14","author":"Jubber","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s00256-021-03887-5","article-title":"Pachydermodactyly: The role of ultrasonography, superb microvascular imaging, and elastography in diagnosis","volume":"51","author":"Novais","year":"2022","journal-title":"Skelet. Radiol."},{"key":"ref_20","first-page":"5560071","article-title":"Pachydermodactyly: An underdiagnosed condition in adolescence\u2014A case report and literature review","volume":"2025","author":"Alrubaiaan","year":"2025","journal-title":"Case Rep. Dermatol. Med."},{"key":"ref_21","first-page":"e94382","article-title":"Pachydermodactyly: An Uncommon Benign Digital Disorder","volume":"17","author":"Almeida","year":"2025","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/cup.13359","article-title":"Pachydermodactyly: Case report including clinical and histopathologic diagnostic pitfalls","volume":"45","author":"Barnes","year":"2018","journal-title":"J. Cutan. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"bcr0120113719","DOI":"10.1136\/bcr.01.2011.3719","article-title":"A 12-year-old boy presenting with unilateral proximal interphalangeal joint swelling","volume":"2011","author":"Small","year":"2011","journal-title":"BMJ Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"360","DOI":"10.4274\/imj.galenos.2019.29053","article-title":"A rare case in rheumatology clinical practice: Pachydermodactyly","volume":"20","author":"Demir","year":"2019","journal-title":"Istanb. Med. J."},{"key":"ref_25","first-page":"43","article-title":"Pachydermodactyly: A case report","volume":"22","author":"Arafah","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_26","first-page":"643","article-title":"Pachydermodactyly\u2014Role of local corticotherapy","volume":"118","author":"Andrese","year":"2018","journal-title":"Int. Med. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"258","DOI":"10.5021\/ad.2011.23.2.258","article-title":"A case of pachydermodactyly","volume":"23","author":"Seo","year":"2011","journal-title":"Ann. Dermatol."},{"key":"ref_28","first-page":"7641","article-title":"Influence of mechanical stimulation on human dermal fibroblasts derived from different body sites","volume":"8","author":"Kuang","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e79992","DOI":"10.5812\/ircmj.79992","article-title":"Pachydermodactyly: A rare type of macrodactyly as a dermatological sign of compulsive behavior and repetitive minor trauma; a case report and review of the literature","volume":"20","author":"Kavecan","year":"2018","journal-title":"Iran. Red Crescent Med. J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/748\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:38:05Z","timestamp":1780634285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["children13060748"],"URL":"https:\/\/doi.org\/10.3390\/children13060748","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}