An 18-year-old male presented with a 2-year history of asymptomatic proximal interphalangeal (PIP) joints swelling involving the second, third, and fourth fingers of both hands (Figure 1). No morning stiffness, rashes, or other symptoms were reported. Family history was unremarkable. Range of joint motion was normal. Blood tests including rheumatoid factor, C-reactive protein, HLA-B27, antinuclear antibody, and extractable nuclear antigen were all negative or within normal limits. X-ray of the hands showed soft tissue swelling around PIP joints, without articular narrowing or bony erosions (Figure 2).