Dactylitis: Difference between revisions
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*Hand-foot syndrome | *Hand-foot syndrome | ||
*Vasoocclusive pain episodes in small bones of hand and feet | *Vasoocclusive pain episodes in small bones of hand and feet | ||
*Typical presentation is in infants with sickle cell disease | *Typical presentation is in infants with [[sickle cell disease]] | ||
**45% infants with sickle cell will have this before age 2 | **45% infants with sickle cell will have this before age 2 | ||
**Rare in older children | **Rare in older children | ||
*Possible predictor of severity of disease | *Possible predictor of severity of disease | ||
*Also seen in adults with seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis) | *Also seen in adults with seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis) | ||
*Also seen in tuberculosis and leprosy | *Also seen in [[tuberculosis]] and [[leprosy]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Dactylitis.png| | [[File:Dactylitis.png|thumb]] | ||
*Painful, symmetrical swelling of hands or feet | *Painful, symmetrical swelling of hands or feet | ||
*Mild erythema | *Mild erythema | ||
*Low-grade fever | *Low-grade [[fever]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Osteomyelitis]] | *[[Osteomyelitis]] | ||
*Other etiologies of [[arthritis]] | *Other etiologies of [[arthritis]] | ||
*Trauma | *[[Trauma (peds)|Trauma]] | ||
{{Sickle cell DDX}} | {{Sickle cell DDX}} | ||
== | ==Evaluation== | ||
*XR often appears normal acutely | *XR often appears normal acutely | ||
*Recurrent episodes can cause a mottled appearance to small bones of affected areas | *Recurrent episodes can cause a mottled appearance to small bones of affected areas | ||
==Management== | ==Management== | ||
*Hydration | *[[IVF|Hydration]] | ||
*Anti-inflammatory agents | *[[NSAIDs|Anti-inflammatory]] agents | ||
*Warm packs | *Warm packs | ||
*Analgesia | *[[Analgesics and sedatives (peds)|Analgesia]] | ||
*Hydroxyurea for recurrent episodes | *[[Hydroxyurea]] for recurrent episodes | ||
==Disposition== | ==Disposition== | ||
*Inpatient admission if pain is not adequately controlled | *Inpatient admission if pain is not adequately controlled | ||
==See Also== | ==See Also== | ||
*[[Sickle cell crisis]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<UpToDate> | <UpToDate> | ||
[[Category:Heme/Onc]] | |||
[[Category:Pediatrics]] | |||
Latest revision as of 00:19, 1 October 2019
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
- Parvovirus B19
- Splenic sequestration
- CVA
- Cerebral aneurysm and ICH
- Priapism
- Papillary necrosis
Evaluation
- 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
See Also
External Links
References
<UpToDate>