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Idiopathic osteolysis of the middle phalanx in an adult patient

Grazyna Orlowska-Kowalik, Teresa Malecka-Massalska, Andrzej Ksiazek

Am J Case Rep 2010; 11:24-28

ID: 878331

Published: 2010-01-19

Background: Progressive osteolysis with disappearance of the carpal and tarsal bones occurs as a rare syndrome often associated with serious nephropathy. Renal failure as a final outcome is more prevalent in some forms of this syndrome than in others. The disease has also been described in patients as young as 1 month to as old as 75 years. The monitoring parameters associated with kidney diseaserelated bone destruction and with its treatment are included in the guideline recently established by Kidney Disease: Improving Global Outcomes (KDIGO) in 2005.
Case Report: The case of a 58-year-old woman treated with long-standing hemodialysis who developed osteolysis of the middle phalanx of the 3rd finger of the right hand after previous removal of the distal phalanx is presented.
Conclusions: A diagnosis of idiopathic osteolysis was made in this patient with a history of chronic renal insufficiency and failed cadaver transplant who presented with the chief complaint of bone ache in her right hand. This diagnosis was confirmed by X-ray of the hand and by histopathology. Although other pathological processes were present in this patient, including chronic hyperthyroidism, hyperparathyroidism, osteoporosis, diabetes mellitus, infections, and vasculitis, there was no conclusive evidence elucidating their roles in this process. Amputation of the phalanx relieved the symptoms and the patient was discharged from the hospital with the recommendation of further maintenance dialysis in her home clinic.

Keywords: Vasculitis, hemodialysis, Osteolysis, Hyperparathyroidism