[A rare cause of pseudoclubbing (pseudohippocratic finger): the acrometastasis. A case report]

The authors report a case of acrometastasis in a patient with breast carcinoma who, after nine years of remission, developed multiple osseous metastases including one in the distal phalanx of her right little finger. The patient who was aged 48, presented with a painful swelling of the distal end of the right little finger. Three weeks previously, she had been diagnosed with multiple osseous metastases. A distal interphalangeal disarticulation was advised and was performed without complications. Histological examination confirmed the diagnosis of metastasis of adenocarcinoma. The clinical picture of acrometastasis is generally dominated by pain, but a presentation similar to a whitlow is also possible. When the lesion is distal, amputation is preferred except possibly in the case of the thumb. Clubbing must be differentiated from pseudoclubbing. Clubbing is a nail deformation affecting all digital rays of one or both hands. It belongs to the syndrome of hypertrophic osteoarthropathy whose systemic etiologies are numerous. Pseudoclubbing is an atypical deformation, concerning one or more rays, and is asymmetrical; its causes are different and can be local. The normal angle of Lovibond is approximately 160 degrees, it is greater than 180 degrees in clubbing and less than 180 degrees in pseudoclubbing. Clinical examination makes it possible to differentiate these two signs and must be supplemented by radiographic examination.