Dactylitis

Background

• Hand-foot syndrome
• Vasoocclusive pain episodes in small bones of hand and feet
• Typical presentation is in infants with sickle cell disease
  • 45% infants with sickle cell will have this before age 2
  • Rare in older children
• Possible predictor of severity of disease
• Also seen in adults with seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis)
• Also seen in tuberculosis and leprosy

Clinical Features

• Painful, symmetrical swelling of hands or feet
• Mild erythema
• Low-grade fever

Differential Diagnosis

• Osteomyelitis
• Other etiologies of arthritis
• Trauma

Sickle cell crisis

• Vaso-occlusive pain crisis
• Bony infarction
• Dactylitis
• Avascular necrosis of femoral head
• Acute chest syndrome
• Asthma
• Pulmonary hypertension
• Gallbladder disease
• Acute hepatic sequestration
• Infection
  • Meningitis
  • Pneumonia
  • Septic joint
  • Osteomyelitis
• Parvovirus B19
• Splenic sequestration
• CVA
• Cerebral aneurysm and ICH
• Priapism
• Papillary necrosis

Diagnosis

• XR often appears normal acutely
• Recurrent episodes can cause a mottled appearance to small bones of affected areas

Management

• Hydration
• Anti-inflammatory agents
• Warm packs
• Analgesia
• Hydroxyurea for recurrent episodes

Disposition

• Inpatient admission if pain is not adequately controlled

References

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