Spinal dysraphism presenting as acro-osteolysis: report of four cases

Lost bones: differential diagnosis of acro-osteolysis seen by the pediatric rheumatologist

INTRODUCTION

Acro-osteolysis is a radiographic finding which refers to bone resorption of the distal phalanges. Acro-osteolysis is associated with various conditions and its presence should prompt the clinician to search for the underlying etiology. The aim of this review is to discuss disorders with which acro-osteolysis is associated and their distinguishing features, with a focus on the pediatric population.

METHODS

A targeted literature review was performed using the term "acro-osteolysis" in combination with other key terms. The primary search results were supplemented using reference citations. Articles published prior to the year 2000 were included if they described additional associations not encountered in the more recent literature.

RESULTS

Genetic disorders (particularly primary hypertrophic osteoarthropathy and skeletal dysplasias) and rheumatic diseases (particularly psoriatic arthritis and systemic sclerosis) are the most frequently encountered conditions associated with acro-osteolysis in children. Hyperparathyroidism, neuropathy, local trauma and thermal injury, and spinal dysraphism should also be included in the differential diagnosis.

CONCLUSION

Although acro-osteolysis is uncommon, its presence should prompt the clinician to consider a differential diagnosis based on clinical and radiographic features.

Occult dysraphism presenting with acro-osteolysis

The skin and the nervous system share common embryologic origins. Cutaneous stigmata may be early clues to underlying occult spinal dysraphism. The delayed manifestations of spinal dysraphism may also involve the skin. We report a case of a 4-year-old child in whom acro-osteolysis and cutaneous trophic changes on the right foot were the presenting features of occult dysraphism.