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

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

Differential Diagnosis

Sickle cell crisis

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

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