UNILATERAL LOWER LIMB HYPERTROPHIC OSTEOARTHROPATHY DUE TO AORTIC GRAFT INFECTION AND AORTOENTERIC FISTULA

Secondary hypertrophic osteoarthropathy (HOA) is a clinical and radiological syndrome consisting in periostal new bone formation, digital clubbing and synovitis. It occurs most commonly in association with intrathoracic malignant diseasesl-B; it has also been described associated with chronic intraabdominal processes such as Crohn's disease, cirrhosis and hepatic neoplasms. 4 The clinical manifestations of HOA include subperiostal cancellous bone formation at the level of diaphysis of tubular bones, arthritis with noninflammatory synovial fluid, and clubbing of fingers or toes. 5 Characteristic clinical features are generally symmetrical, involving both upper and lower limb. Changes in the lower limb rarely occur in the absence of upper limb abnormalities, 6 even rarer is the restriction of HOA to one isolated limb. 1° The pathophysiology of HOA is unknown and the theories proposed remain speculative; HOA most likely repre7 8 11 12 sents a nonspecific response to noxious humoral ' ' " or neural stimuli. ~-3 Some authors have reported examples of this disorder confined to the bones of one or two limbs in association with the presence of infected Dacron grafts, some of them complicated with aortoenteric 7 17 fistula.The purpose of this communication is to report a new case with similar clinical characteristics, stressing the diagnostic value of HOA in the early detection of graft infection.