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A 63-year-old woman with osteoarthritis and obstructive sleep apnea treated with nasal continuous positive airway pressure (CPAP) presented with several months of worsening pain in her hands (first metacarpophalangeal joints), wrists, and feet. Radiographs of the hands and wrists performed 1 month prior showed degenerative changes but no bone erosions. Her vital signs and physical examination findings were normal. She had no redness, warmth, or swelling of any joints, and her skin examination was unremarkable. However, a deformity of the nasal bridge was noted after she was asked to remove her face mask, which she was wearing as required during the COVID-19 pandemic. She reported no history of facial trauma, recent travel, illicit drug use, or high-risk sexual behavior. The nasal deformity, which she attributed to use of her CPAP mask, had developed gradually over the past several years.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.