Adult-Onset Phalangeal Microgeodic Syndrome: A Case Report and Literature Review

Abstract

Phalangeal microgeodic syndrome (PMS) is a rare condition thought to result from a transient disturbance of peripheral circulation under cold temperatures. PMS is most prevalent in children, mainly affecting the fingers and rarely the toes. Although some cases of adult-onset PMS have been reported, the clinical features remain unclear. Herein, I report the case of a 24-year-old man who developed PMS with toe involvement. The self-limiting course was followed by magnetic resonance imaging (MRI). Furthermore, I performed a literature review and summarized the characteristics of this case and eight previously reported adult-onset PMS cases (n=9). The median patient age was approximately 43 (range: 18-89) years, and most cases were diagnosed based on frostbite-like symptoms in winter and specific MRI findings, despite normal radiographic findings. While adult-onset cases had similar clinical and imaging features to child-onset cases, toe involvement was frequent (5/9 [56%]), and female patients were dominant (8/9 [89%]). Two patients had immune-mediated diseases, such as systemic lupus erythematosus and psoriasis. These reports suggest that adults and children with PMS have some different clinical characteristics. Thus, clinicians should consider PMS when finger or toe pain occurs in cold environments, even in adults.

Keywords: adult-onset; bone lesion; mri images; phalangeal microgeodic syndrome; toe pain.

Figure 1. Foot X-ray findings.

An anteroposterior radiograph of the left foot shows no abnormalities.

Figure 2. Magnetic resonance imaging (MRI) findings of toes.

(A–D) The initial MRI findings. Low-signal intensity on T1-weighted images (T1WI: A and C) and high-signal intensity on short-inversion time-inversion recovery images (STIR: B and D) are observed in the bone marrow of the first, second, and third distal and fifth proximal phalanges of toes (arrowheads). (E–F) The follow-up MRI findings. Significant improvement of the abnormal findings detected in the initial MRI examination is observed (arrowheads). (E) T1WI and (F) STIR.