Recurrent Osteomyelitis Requiring Surgical Management Secondary to Nail-Biting

Hoof, Marcus; Cognetti, Daniel J.; McClain, William D.; Plucknette, Benjamin F.

doi:10.2106/jbjs.cc.21.00346

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Onychophagia begins in childhood and is usually resolved over time. The prevalence of nail biting between the ages of 17-35 is 21.5% with a bigger decrease in the prevalence after the age of 40 [ 5 ]. Though, these numbers are likely underestimated due to reluctance in seeking medical care and can range from 3% - 46.9% among different population groups [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…It affects 20-30% of the population in all age groups [ 3 ]. Human bites have the potential to become serious injuries due to the high virulence of the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room [ 1 , 3 - 5 ]. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Rivera¹,

Marín-Aragón²,

Thomas³

et al. 2022

Cureus

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Onychophagia is a habitual nail-biting disorder, usually associated with mental or emotional diseases. It affects 20-30% of the population in all age groups. Human bites have the potential to become serious injuries due to high virulence in the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately. We present a 49-year-old Spanish-speaking gentleman, with a past medical history of repetitive nail biting secondary to severe anxiety, major depression disorder, bilateral hand neuropathy secondary to diabetes mellitus (DM) type 2 who was initially admitted to the hospital due to cellulitis of the fingers with suspected osteomyelitis in the right hand. Anxiety was being treated by psychiatrist with paroxetine however, given no improvement and prolonged follow-ups, the primary care physician (PCP) added hydroxyzine and scheduled alprazolam in an attempt to minimize symptoms. Despite these efforts, patient continued with nail biting. On initial physical exam, the patient had a lack of fingernails and multiple wounds at various stages of healing across all digits. The distal and middle phalanges of the third right digit showed increased erythema and swelling and band tightening. Patient was started on broad-spectrum antibiotics. Initial radiography of the right hand was concerning for osteomyelitis which was later confirmed with Magnetic Resonance Imaging (MRI). Infectious disease specialist agreed on a course of cefepime, vancomycin and metronidazole. On admission, hand surgeon did not see a need for amputation and patient was treated conservatively. Due to minimal improvement after six days on IV antibiotics, patient underwent fasciotomy of the flexor compartment of the right middle finger after patient rejected hand surgeon's recommendation for amputation. He was discharged to a skilled nursing facility where he was to continue intravenous antibiotics for an additional four weeks. The vulnerable patient population of South Texas is predominately Hispanic, Spanish-speaking and uninsured. It is imperative to treat psychiatric disorders early to prevent complications, however, given the low numbers of psychiatrists in the Rio Grande Valley and even fewer who speak Spanish it is not unusual to find an appointment in more than six months. In this case, we observe how a trivial everyday behavior can lead to limb-threatening complications if not treated early and appropriately.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Rivera¹,

Marín-Aragón²,

Thomas³

et al. 2022

Cureus

View full text Add to dashboard Cite

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Onychophagia Progressing to Extensive Finger Amputation: A Brief Review Addressing Severe Body-Focused Repetitive Behavior Disorder in an Adult

Whig¹,

Nagra²,

Merkel³

et al. 2023

Psychiatric Annals

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Individuals engaging in repetitive, persistent and intentional behaviors resulting in significant self-injury can, for many medical and psychiatric care providers, stir vexing questions as to how such behavior should be conceptualized and managed. Onychophagia (nail-biting), categorized as a Body-Focused Repetitive Behavior Disorder (BFRBD) in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition , is a common oral habit, observed in both children and adults. For most persons, the nail-biting is merely a cosmetic concern that does not attract clinical attention. Although more extreme forms of this behavior can manifest with moderate complications, we present an unusual case of an adult for whom persistent onychophagia progressed to significant injury to his hands due to recurrent osteomyelitis. Emerging research exploring the underpinnings of severe forms of BFRBDs are discussed. This case illuminates management challenges that can arise when clinicians fail to recognize the condition and highlights the need for early coordinated multidisciplinary intervention to mitigate the behavior and its sequelae longitudinally. [ Psychiatr Ann . 2023;53(3):145–148.]

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Recurrent Osteomyelitis Requiring Surgical Management Secondary to Nail-Biting

Cited by 2 publications

References 8 publications

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Onychophagia Progressing to Extensive Finger Amputation: A Brief Review Addressing Severe Body-Focused Repetitive Behavior Disorder in an Adult

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