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.