Endocrine Abstracts

Hypertrophic osteoarthropathy (HOA) is a syndrome characterized with proliferation of bones at the distal parts of extremities. Clubbing, periostitis of tubular bones and non-inflammatory arthritis of lower extremities are commonly seen as a part of this syndrome.

66 years old male patient was admitted to our hospital with painful swelling of his left lower extremity for 2 months. He denies any other systemic symptoms such as fever and weight loss. He had history of aortailiac bypass surgery 5 years ago. On physical examination there were pitting edema on his left leg and clubbing of the toes, no hyperemia or temperature increase was found. His bone scan revealed increased osteoblastic activity on left anterior iliac spine and also diffuse expansive heterogen osteoblastic activity was seen on left humerus, tibia, fibula and digital bones. This involvement was decided as Paget’s disease and he was treated with parenteral zoledronic acid in another center. On his admission to our hospital, periostal reaction of bilateral femur and tibia was seen on plain radiographs. HOA was decided as preliminary diagnosis. Positron emission tomography (PET) was performed in order to identify the etiology of HOA and revealed bilateral heterogen periostal reaction of lower extremities confirming HOA. Also there was increased FDG activity on abdominal aorta and iliac bifurcation indicating aortitis. Contrast enhanced abdominal CT showed periaortitis caused by a fistula between aortic graft wall and 3. part of the duodenum. The fistula tract was not connected with vascular lumen. Daptomicine 350 mg/day and Ertapenem 1 g/day were started. Revision of the graft was planned during cardiovascular surgery consultation. The patient will be operated after 6 weeks of antibiotic treatment is completed.

Vascular graft infection, as reported here, is a rare cause of secondary HOA, but it might be strong and important sign of infection of vascular prosthesis.