Acrodynia Clinical Presentation

Updated: Jun 21, 2018
  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Children initially become listless, drowsy, and irritable, with a tendency to cry. Anorexia and subsequent weight loss can occur. More than 50% of patients demonstrate photophobia. Hypotonia, the ability to hyperextend or overextend the limbs, and atrophy of muscles are noted. The child may refuse to walk.

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Physical Examination

The initial symptoms are followed by the numerous cutaneous manifestations in 2-4 weeks. The skin changes are characteristic. The review by Dinehart et al from 1988 is notable. [9]  Early in the course of the disease, the tip of the nose, fingers, and toes acquire a pinkish color, which subsequently develops into a reticulate erythema of deeper hue. [10]

The hands and feet become painful, cold, cyanotic, erythematous, and swollen. Erythema is usually blotchy but may be diffuse. Hemorrhagic puncta are also noted. On the trunk, the erythema is blotchy and may be macular or papular. Extreme pain and pruritus in the extremity often leads to lichenified, excoriated changes as the child constantly rubs and scratches his or her skin. Patients may assume the "salaam position" in which they sit with their heads between their legs and rub their hands together.

Inflammation, swelling, and focal gum erosion can been seen with subsequent loss of teeth. These changes are early.

A notable symptom is massive hyperhidrosis with a mouselike smell, which may lead rapidly to miliaria rubra. This can easily turn to bacterial secondary infection with a tendency for ulcerating pyoderma.

Persistent hypertension, tachycardia, susceptibility to bronchitis, dyspepsia, precipitant micturition, salivation, and hypotonia can be observed. Usually, the patient develops a moderate upper respiratory tract infection with a sore throat. [11]

Alopecia has been noted. Nail loss has also been reported.

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Complications

Long-term disability has been noted. Some patients have been shown to have lower intelligence test scores and abnormal electroencephalographic tracings, indicating possible organic damage to the CNS.

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