Dactylitis as an Earty Onset of Sickle Cell Disease Pain

Clinical Image

A 12-month-old child with homozygous sickle cell disease diagnosed at birth consulted at the hospital because of limited manual dexterity and crying out in apparent pain for a few days. No other symptom was referred. A previous medical assessment had been unremarkable. On physical examination, the patient was stable, a febrile, with normal vital signs. He had swelling on the dorsal aspect of the right hand with no other signs of inflammation. The remaining exam was uneventful. A radiographic examination revealed a periostic reaction at the 3^rd and 5^th metacarpal bones. A diagnosis of dactylitis was made and the child was treated with oral analgesics, anti-inflammatories and hydration at home.

Dactylitis are episodes of vaso-occlusive pain in small bones of the hands and feet that develop in children during the first 4 years of life, before the haematopoietic tissue in these locations is replaced by fibrous connective tissue and fat. Osteomyelitis should be considered in the differential diagnosis.

    

    

    Figure 1: