Avascular necrosis of the metacarpal head: Dieterich's disease

A 68-year-old woman presented with an osteolytic image on the metacarpal head of the ring finger, first attributed to inflammatory or septic arthritis. She had experienced increasing pain three months before presentation, requiring orthopaedic treatment. At the time of clinical assessment, there was some limitation in the range of movement, accompanied by local pain and chronic swelling. Inflammatory arthritis was not confirmed on laboratory testing or scintigraphy. A diagnosis of Dieterich's disease was established based on the evolution of the condition, with chronic limitation of movement and no associated findings. Surgical treatment by arthroplasty was suggested, but was not accepted by the patient, given her satisfactory functional status.