Hypertrophic Osteoarthropathy Secondary to Vascular Prosthesis Infection

Abstract

An infected vascular graft is an uncommon association in hypertrophic osteoarthropathy (HOA) but is important because of potential catastrophic complications. Here we describe 3 new patients with HOA secondary to vascular prosthesis infection and review the other 23 patients described in the English literature with this clinical syndrome. The finding of symptoms and signs of localized HOA in patients with arterial prosthesis may be the presenting manifestation of graft sepsis. In most patients the graft is located at the aorta or aortic bifurcation. The initial symptoms are fever, joint pain mainly involving the knees and ankles, clubbing, and in some cases intestinal bleeding. Recurrent abscesses and bacteremia arising in spite of appropriate antimicrobial therapy are prominent infectious signs. Another characteristic feature is the wide variety of bacteria isolated from a single patient. When a polymicrobial enteric flora is isolated from the blood or other tissue, an intestinal origin of infection can be readily suspected. Gallium or leukocyte scans are useful for detecting an abscess around the vascular prosthesis. In some cases, the detection of gas around the graft demonstrated by computed tomography is highly suggestive of prosthesis infection. Mechanisms involved in the pathogenesis of HOA associated with aortic graft infection are unknown. Treatment consists of intravenous antibiotics and surgical replacement of the infected graft. The prognosis of arterial prosthesis infection depends greatly on early diagnosis and treatment before the onset of life-threatening complications. Knowledge of this rare association may lead to an early diagnosis and appropriate management of this serious and often fatal complication.

Granulosa thecal cell tumour in a mare causing hypertrophic osteopathy

“…There is a significant increase in the expression of these 2 cytokines in hypoxic conditions and together they are thought to induce the changes associated with HOA (Atkinson and Fox 2004). Humoural pathway involvement has also been suggested, including an association of HOA with vascular prosthesis infection (Alonso‐Bartolomé et al . 2006) in humans, and an actinomycetes bacterial infection as the suggested cause of HO (based on response to antimicrobial treatment) was recently reported in a 2‐year‐old filly (Lewis et al .…”

“…The initial process appears to involve an increased blood flow to the distal limbs, but it is not known how or why this occurs. Humoural (Alonso-Bartolomé et al 2006), neurological mechanisms (Yacoub 1965;Treasure 2006), hypoxia and cytokine release (Dickinson and Martin 1987;Atkinson and Fox 2004), and arteriovenous shunting have all been suggested to cause HO. Studies so far have been unsuccessful in establishing the cause in man (Nguyen and Hojjati 2011) or animals (Mair et al 1996;Mair and Tucker 2004).…”

Hypertrophic Osteoarthropathy on Bone Scintigraphy

“…Among patients with lung cancer, hypertrophic osteoarthropathy is associated most frequently with adenocarcinoma and least frequently with small cell carcinoma (1). Rarely, arterial vascular prosthesis infections may be associated with hypertrophic osteoarthropathy (2). Bone scintigraphy is a sensitive way to detect involvement.…”

Hypertrophic Osteoarthropathy and Digital clubbing in Lung Adenocarcinoma

“…1 Rarely, arterial vascular prosthesis infections may be associated with HOA. 3 Clinical features suggestive of vascular infection-related HOA include clubbing or periosteal new bone formation in a single limb (in the case of upper extremity arterial prostheses), or unilateral or bilateral lower extremity involvement in the case of arterial grafts to the legs or aortic prostheses.…”