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Unilateral Hypertrophic Osteoarthropathy in a Patient With a Vascular Graft Infection

Ahrenstorf, Gerrit MD*; Rihl, Markus MD; Pichlmaier, Maximilian A. MD; Rosenthal, Herbert MD§; Witte, Torsten MD*; Schmidt, Reinhold E. MD*

JCR: Journal of Clinical Rheumatology: September 2012 - Volume 18 - Issue 6 - p 307–309
doi: 10.1097/RHU.0b013e3182614d08
Case Reports

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.

From the Clinics for *Immunology and Rheumatology and †Rehabilitation Medicine, ‡Heart, Thoracic, Transplantation and Vascular Surgery, and §Institute for Radiology, Hannover Medical School, Hannover, Germany.

The authors declare no conflict of interest.

Correspondence: Gerrit Ahrenstorf, MD, Clinic for Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.