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Dactylitis
From WikEM
Contents
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
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