Distal phalangeal osteomyelitis of bilateral thumbs secondary to onychodystrophy – a case report with review of literature

Abstract

Distal phalangeal osteomyelitis of the thumb occurs rarely. Bilateral affection of the distal phalanges has not been described in the literature so far. Here, we present a case study of a patient who was successfully treated for distal phalangeal osteomyelitis of bilateral thumbs. A 65-year-old woman presented with bilateral thumb pain and swelling. She had dyschromic changes in the right nail and onychodystrophic changes in the left nail. On inquiry, she gave a history of applying nail enamel only to both thumbs for several years. Radiography of both the thumbs showed changes suggestive of osteomyelitis of the distal phalanges. She was treated successfully with debridement and sequestrectomy. Culture from necrotic tissue yielded polymicrobial flora. Onychodystrophy is relatively common and occurs secondary to infective as well as non-infective disorders of nails. Compulsive nail biting (onychophagia), nail picking, and allergic and irritant contact dermatitis secondary to cosmetic agents and household detergents are common predisposing factors. A high degree of suspicion of infective nail bed can aid in the early treatment of such cases with favorable outcome.