Microgeodic disease in an infant

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.

Keywords: Dermatology; Paediatrics; Primary Care; Rheumatology.

Figure 1

Right hand at presentation.

Figure 2

Generalised oedema and erythema of the right four fingers extending to the palm at presentation.

Figure 3

X-ray of right hand at presentation demonstrating rarefaction and periosteal reaction in the third, fourth and fifth middle phalanges, distal fourth phalanx, proximal third and fifth phalanges. Associated cortical punched out metaphyseal lesions and swelling of the overlying soft tissues are evident.

Figure 4

Ultrasound image showing hypoechoic thickened periosteum over the fifth proximal phalanx (PP).

Figure 5

Colour Doppler ultrasound image showing hyperaemia of the periosteum of the fifth proximal phalynx (PP).

Figure 6

Coronal T2-weighted fat suppressed MRI of the right hand showing diffuse marrow oedema of the involved phalanges and intramedullary lytic areas with extensive surrounding soft-tissue inflammation.

Figure 7

X-ray of right hand at resolution.