Intravenous drug addiction is responsible for many complications, especially 
cutaneous and infectious. There is a syndrome, rarely observed in rheumatology, 
resulting in "puffy hands": the puffy hand syndrome. We report two cases of this 
condition from our rheumatologic consultation. Our two patients had intravenous 
drug addiction. They presented with an edema of the hands, bilateral, painless, 
no pitting, occurring in one of our patient during heroin intoxication, and in 
the other 2 years after stopping injections. In our two patients, additional 
investigations (biological, radiological, ultrasound) were unremarkable, which 
helped us, in the context, to put the diagnosis of puffy hand syndrome. The 
pathophysiology, still unclear, is based in part on a lymphatic toxicity of 
drugs and their excipients. There is no etiological treatment but elastic 
compression by night has improved edema of the hands in one of our patients.