title: Unilateral hypertrophic osteoarthropathy in a patient with a vascular graft infection.
abstract: We report a patient who presented with high fever; a unilateral, palpable tender swelling along the right shin; and effusions in knee and ankle joints leading to the diagnosis of hypertrophic osteoarthropathy (HOA). The diagnostic workup revealed an infected vascular graft that had been implanted 2 years before because of a ruptured infrarenal aortic aneurysm as the cause of HOA. The patient was treated successfully with antibiotics and surgically replacing the infected graft. Hypertrophic osteoarthritis is a clinical entity characterized by digital clubbing, periostitis, and synovial effusions. Primary and secondary forms have been described. Secondary HOA develops as a consequence of various diseases, mainly intrathoracic malignancies. Vascular graft infection, as reported here, is a rare cause of HOA. This case underlines the typical clinical features of HOA and the importance of a prompt and comprehensive diagnostic workup in cases of HOA. Our aim is to sharpen the awareness of its multiple underlying causes. Unilateral HOA is a rare but strong and important sign of infection of vascular prosthesis.
authors.affiliation: Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany. Ahrenstorf.Gerrit@mh-hannover.de
authors.forename: Gerrit
authors.initials: G
authors.lastname: Ahrenstorf
authors.forename: Markus
authors.initials: M
authors.lastname: Rihl
authors.forename: Maximilian A
authors.initials: MA
authors.lastname: Pichlmaier
authors.forename: Herbert
authors.initials: H
authors.lastname: Rosenthal
authors.forename: Torsten
authors.initials: T
authors.lastname: Witte
authors.forename: Reinhold E
authors.initials: RE
authors.lastname: Schmidt
mesh_terms: D001019:Aortic Rupture / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000175:diagnosis / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000209:etiology*; D014057:Tomography, X-Ray Computed