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Borges T, Castro M. Phalangeal microgeodic syndrome: case report of a young woman treated with pentoxifylline. Z Rheumatol 2024; 83:303-305. [PMID: 38175270 DOI: 10.1007/s00393-023-01470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Phalangeal microgeodic syndrome (PMS) is a rare osteolytic disorder of unknown etiology that typically affects children up to 15 years old during colder months. Transient peripheral circulatory impairment probably underlines its pathogenesis. Conservative treatment with eviction of cold exposure is often successful. We report the case of a young woman presenting with joint pain in her feet, along with toe discoloration and redness, where a diagnosis of PMS was established based on magnetic resonance imaging findings and exclusion of other differential diagnostic entities. Pharmacological treatment was deemed necessary for symptomatic relief, but a trial of calcium channel blocker (CCB) was not tolerated by the patient. The patient was then started on pentoxifylline, with significant clinical improvement.
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Affiliation(s)
- Tiago Borges
- Hospital Privado de Gaia Trofa Saúde, Rua Fernão de Magalhães, n°2, Fração E 4400-629, Vila Nova de Gaia, Portugal.
| | - Miguel Castro
- Hospital Privado de Gaia Trofa Saúde, Rua Fernão de Magalhães, n°2, Fração E 4400-629, Vila Nova de Gaia, Portugal
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Yoshizaki A, Nishioka H. Microgeodic disease in an older woman. Geriatr Gerontol Int 2023; 23:881-882. [PMID: 37804187 DOI: 10.1111/ggi.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Aisa Yoshizaki
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Hanife N, Bessame K, Mandalia UY. Phalangeal microgeodic syndrome, COVID-19, and antinuclear antibodies in a child: A case report. J Clin Imaging Sci 2022; 12:64. [PMID: 36601602 PMCID: PMC9805605 DOI: 10.25259/jcis_122_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
Phalangeal microgeodic syndrome (PMS) is a rare rheumatological disease affecting children strongly associated with cold weather. It is considered to be benign and self-limiting, with most cases resolving in warmer months, and no studies have investigated its association to autoantibodies or viral infection. In this peculiar case, a 12-year-old child with the previous COVID-19 infection developed PMS that did not improve in the warm weather and, subsequently, Raynaud's phenomenon and facial rash. With the increasing number of new studies showing the correlation between COVID-19 and autoimmunity, this case report highlights a plausible link between COVID-19, PMS, and autoimmunity in the pediatric population that should be investigated further.
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Affiliation(s)
- Nura Hanife
- Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom.,Corresponding author: Nura Hanife, Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom.
| | - Khaoula Bessame
- Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
| | - Uday Yashwant Mandalia
- Department of Radiology, Watford General Hospital, Watford, Hertfordshire, United Kingdom
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Stranks KF, Tiller G, Liyanage N, Bao D. Microgeodic disease in an infant. BMJ Case Rep 2022; 15:e245179. [PMID: 36038154 PMCID: PMC9438064 DOI: 10.1136/bcr-2021-245179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an infant presenting with intermittent discolouration and swelling of her fingers and toes occurring with changes in ambient temperature. Extensive investigations revealed raised inflammatory markers as well as sclerotic lesions within the phalanges and diffuse marrow oedema. Infectious and inflammatory causes were considered and excluded based on the clinical presentation and investigation findings. The persistence of symptoms prompted further investigation with MRI. Correlation of the MRI findings with previous case reports resulted in a diagnosis of microgeodic disease-an uncommon, self-limiting condition thought to be due to cold-induced vasospasm leading to avascular necrosis of the bone.
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Affiliation(s)
| | - Georgina Tiller
- Rheumatology, Monash Children's Hospital, Clayton, Victoria, Australia
- Rheumatology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Neelika Liyanage
- Radiology Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Danielle Bao
- General Paediatrics, The Royal Children's Hospital, Parkville, Victoria, Australia
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Ellatif M, Sahu A, Abraham S, Rosenbloom C, Chatterjee R. Rare case of adult-onset phalangeal microgeodic syndrome of the feet. BMJ Case Rep 2021; 14:14/4/e242256. [PMID: 33837037 PMCID: PMC8043032 DOI: 10.1136/bcr-2021-242256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Phalangeal microgeodic syndrome (PMS) is a rare condition typically affecting children and is characterised by painful digits precipitated by cold temperatures. In medical literature, cases appear to be clustered in Japan. Adult-onset PMS is particularly rare and although imaging features are characteristic, it may go undiagnosed, as it is not commonly encountered. We present, to our knowledge, the fifth reported case in the literature of adult PMS, the second to affect the feet rather than hands, and the first in a Caucasian adult patient. This case report aims to raise awareness of this likely underdiagnosed condition to allow optimal management and avoidance of unnecessary diagnostic procedures.
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Affiliation(s)
- Mostafa Ellatif
- Radiology Department, London North West Healthcare NHS Trust, Harrow, UK
| | - Ajay Sahu
- Radiology Department, Ealing Hospital, London, UK
| | - Sonya Abraham
- Imperial College Healthcare NHS Trust, London, London, UK
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Phalangeal microgeodic syndrome in childhood. Pediatr Radiol 2018; 48:1108-1112. [PMID: 29736770 DOI: 10.1007/s00247-018-4137-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/14/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Phalangeal microgeodic syndrome is an uncommon benign self-limiting condition that often occurs during cold weather. The etiology and the pathogenesis of the disease remain unclear. OBJECTIVE To report a series of children with phalangeal microgeodic syndrome. MATERIALS AND METHODS Twenty children with phalangeal microgeodic syndrome were retrospectively identified at our hospital after 2007. The clinical data, radiologic manifestation and pathologic appearance were analyzed. RESULTS The average age was 10.3 years (range: 6.5-14.6 years). Twelve patients were boys. Twenty-five phalanges were affected radiographically (23 middle phalanges [92%] and 2 proximal phalanges [8%]). On radiographs, there were multiple small phalangeal lacunae in all cases. Metaphyseal rarefaction was seen in 15 phalanges, and metaphyseal transverse lucent bands were found in 7 phalanges. Epiphyseal rarefaction was seen in three phalanges. On magnetic resonance imaging (MRI), diffuse signal abnormalities of affected phalanges were observed in all cases. Multiple other phalanges and metacarpals also showed marrow edema in three cases. CONCLUSION Phalangeal microgeodes may represent bone absorption and destruction in response to exaggerated peripheral circulatory impairment following chilblain, and mainly occur in bone growth spurts.
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Radhakrishnan R, Emery KH, Merrow AC. Diffuse phalangeal signal abnormality on magnetic resonance imaging: phalangeal microgeodic disease. Pediatr Radiol 2017; 47:313-320. [PMID: 28101593 DOI: 10.1007/s00247-016-3763-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/25/2016] [Accepted: 12/05/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Phalangeal microgeodic disease is a rare and benign self-limited condition involving the phalanges, often in the setting of cold exposure, with characteristic MR imaging abnormalities. Radiographic case descriptions are predominantly from Asia and Europe, with only seven cases using MR to characterize phalangeal microgeodic disease. OBJECTIVE In this study we describe the MR imaging appearance of unusual and striking phalangeal signal abnormality compatible with phalangeal microgeodic disease at our institution in North America. MATERIALS AND METHODS We retrospectively reviewed cases presenting at our institution with unusual or unexplained phalangeal signal abnormalities between 2001 and 2014. We reviewed the MR imaging appearances in conjunction with radiographs and any other available imaging investigations. RESULTS Of 189 examinations reviewed during the study period, 8 imaging studies in 6 patients met the study inclusion criteria. Signal abnormality was present in 57 of 112 phalanges (51%), frequently involving the distal phalanges (70%, 28 of 40), followed by the middle phalanges (56%, 18 of 32) and the proximal phalanges (28%, 11 of 40). The pattern of involvement was most commonly diaphysis (38%), followed by metaphysis (32%) and epiphysis (30%). The extent of MR signal abnormality was greater than that suspected based on clinical presentation or on radiographs. CONCLUSION The presence of unexplained diffuse characteristic marrow involvement of multiple painful phalanges on MR images, often in the setting of cold exposure, should raise the possibility of phalangeal microgeodic disease. Consideration of this diagnosis based on MR findings would lead to a more conservative management and avoid unnecessary invasive diagnostic procedures.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Kathleen H Emery
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
| | - Arnold C Merrow
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
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Tetsunaga T, Endo H, Fujiwara K, Tetsunaga T, Ozaki T. Microgeodic Disease Affecting the Fingers and Toes in Childhood: A Case Report. Open Orthop J 2016; 10:500-504. [PMID: 27843512 PMCID: PMC5080871 DOI: 10.2174/1874325001610010500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 11/25/2022] Open
Abstract
Microgeodic disease is a disease of unknown etiology that affects the fingers and toes of children, with ≥ 90% of cases involving the fingers alone. We present a rare case of microgeodic disease affecting an index finger and two toes simultaneously in a 7-year-old girl. X-ray and magnetic resonance imaging (MRI) showed multiple small areas of osteolysis in the middle phalanges of the left index finger, hallux, and second toe. Microgeodic disease was diagnosed from X-ray and MRI findings, and conservative therapy involving rest and avoidance of cold stimuli was provided. Although pathological fractures occurred in the course of conservative treatment, the affected finger healed under splinting without any deformity of the finger.
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Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Kazuo Fujiwara
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
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Abnormal Bone Marrow Signal Intensity in the Phalanges of the Foot as a Manifestation of Raynaud Phenomenon: A Report of Six Patients. AJR Am J Roentgenol 2016; 207:1252-1256. [PMID: 27575610 DOI: 10.2214/ajr.16.16366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The objectives of our study were to describe the MRI findings of pedal phalangeal bone marrow edema in patients with Raynaud phenomenon (RP) and discuss the clinical implications of these MRI findings. CONCLUSION There is a progressive distal-to-proximal pattern of pedal phalangeal bone marrow edema on MRI in patients with RP. This knowledge may allow early diagnosis and treatment of rheumatologic disorders that are potentially associated with RP.
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The phalangeal microgeodic syndrome in childhood: awareness leads to diagnosis. Eur J Pediatr 2013; 172:763-7. [PMID: 23371429 DOI: 10.1007/s00431-013-1953-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/19/2013] [Indexed: 01/27/2023]
Abstract
Phalangeal microgeodic syndrome is a rare but benign disorder that affects the fingers of children. This condition was originally described by Maroteaux in 1970. We present two patients who consulted a pediatrician with swelling of the digits of one or both hands. Both lacked additional clinical or biochemical signs. Radiological examination showed multiple small osteolytic areas with sclerotic lining and periostal reactions in the phalanges of the affected hands. These cases were treated with a conservative approach and spontaneous resolution occurred within weeks to months. As it is a rare disease, the clinical presentation can be misinterpreted as an infectious, inflammatory, or even malignant condition and prompts clinicians to expand the diagnostic process with radiological or nuclear imaging and even biopsy. In these patients, a timely clinical diagnosis by a physician who is aware of the disease prevented further investigations.
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