A 44-year-old white woman with Turner syndrome (45,X) presented for a routine rheumatologic examination for episodic oligoarthritis in her right ankle. A complete medical history and physical examination revealed bilateral lower extremity toe lesions. Her left second and third, and her right second, third, and fourth toes demonstrated linear bandlike constrictions between the interphalangeal joints (
Figure) consistent with grade I pseudoainhum. The toes were warm, nontender, and had good capillary refill. There was no clinical evidence to suggest peripheral vascular disease. The patient could not recall how long the painless, asymptomatic lesions had been present. She reported no trauma to the toes or feet.
Notably, the patient did not have a family history of constricting bands, ainhum, or pseudoainhum. She had diffuse xerotic eczema. Medications included daily Protandim, multivitamin, 1000 mg of L-arginine, and 100 mg of celecoxib, as well as approximately 500 mg of acetaminophen per week. She did not smoke cigarettes. Pertinent examination findings included episodic oligoarthritis without any objective evidence of a systemic inflammatory disorder or arthropathy and right first metacarpophalangeal subluxation and short digits. No synovitis, clubbing, nail pitting, or onycholysis were observed, and she was able to clench her fists.
Complete blood cell count, complete metabolic profile, rheumatoid factor, anti–cyclic citrullinated peptide antibodies, antinuclear antibody, and uric acid laboratory test results were within normal limits. Because the incidental toe findings were asymptomatic, an approach to resolution was not considered. However, her chief complaint of oligoarthritis in the right ankle was addressed and recommendations made. The differential diagnosis included systemic inflammatory arthropathy, reactive arthritis, osteoarthritis, and crystal disease. She was advised to continue taking celecoxib and was prescribed orthopedic shoes. Follow-up care was recommended on an as-needed basis.