Graille J, Beylot-Barry M, Drapé J-L, Doutre M-S, Cogrel O
Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
Service de radiologie « B », hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
Ann Dermatol Venereol. 2016 Apr;143(4):284-8. doi: 10.1016/j.annder.2016.01.008. Epub 2016 Mar 2.
Acro-osteolysis (AO) involves partial or total destruction of the distal phalanges of the fingers or toes. The range of forms of AO is extremely wide. A distinction is generally made between the acquired forms and the genetic and idiopathic forms. Herein we report a case of idiopathic transverse single-finger AO associated with onychopathy.
A 48-year-old woman consulted for a nail lesion involving brachyonychia in the right index finger alone (pseudo-clubbing appearance of the finger). The remainder of the clinical examination was normal, particularly in terms of neurological and dermatological investigations. Standard x-rays revealed transverse osteolysis of the middle third of the distal phalanx, occurring solely in the right index finger.
While certainty regarding diagnosis of AO depends upon radiological findings, the radiological appearance is not specific. Two subgroups suggesting aetiological diagnosis may be distinguished: transverse AO with banding and longitudinal AO. With transverse AO, the diaphysis of the distal phalanx presents osteolysis with banding, but with sparing of the base of the band (pseudo-fracture appearance); this appearance is suggestive of toxic causes, congenital familial conditions or repetitive micro-trauma. Upon x-ray examination, the longitudinal forms exhibit concentric resorption of the band and these forms are more often seen in a setting of neurological, vascular or metabolic disorders. The associated nail involvement frequently present helps clarify the diagnosis, with nail plate shape being dependent on the integrity of the underlying bone.
Herein we report the first case of transverse AO in a single finger associated with brachyonychia, and with no discernible cause.
肢端骨质溶解（AO）涉及手指或脚趾远端指骨的部分或全部破坏。AO的形式范围极为广泛。一般可分为后天性形式以及遗传性和特发性形式。在此，我们报告一例与甲病相关的特发性横向单指AO病例。
一名48岁女性因仅累及右手示指的短甲（手指假性杵状指外观）甲病变前来就诊。其余临床检查均正常，尤其是神经学和皮肤病学检查方面。标准X线显示远端指骨中三分之一处横向骨质溶解，仅发生于右手示指。
虽然AO的诊断确定性取决于放射学表现，但放射学表现并不具有特异性。可区分出两个提示病因诊断的亚组：带纹横向AO和纵向AO。对于横向AO，远端指骨干呈现带纹状骨质溶解，但带纹基部未受累（假性骨折外观）；这种表现提示中毒原因、先天性家族性疾病或重复性微创伤。在X线检查中，纵向形式表现为带纹的同心性吸收，且这些形式更常见于神经、血管或代谢紊乱的情况下。相关的甲受累情况经常出现有助于明确诊断，甲板形状取决于其下方骨骼的完整性。
在此我们报告首例单指横向AO合并短甲且无明显病因的病例。
