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Más allá de la piel: pistas ungueales de una enfermedad ósea
Mariana Costa1, Catarina Tavares2, Cristina Alves3
1Pediatrics Department, Coimbra Local Health Unit, Coimbra, PRT.
Cureus
|January 16, 2026
Resumen
La osteomielitis multifocal crónica recurrente (OMFR) en niños puede estar relacionada con la psoriasis. El diagnóstico temprano a través de cambios en las uñas y el tratamiento oportuno con naproxeno, calcitriol y metotrexato lograron la remisión.
Área de la Ciencia:
- Reumatología Pediátrica; Dermatología; Genética
Sus antecedentes:
- La osteomielitis multifocal crónica recurrente (OMFR) es un trastorno óseo autoinflamatorio raro que afecta principalmente a niños.
- Aproximadamente el 25% de los pacientes con OMFR tienen afecciones inflamatorias asociadas, lo que requiere diversos enfoques de tratamiento, desde AINE hasta biológicos.
Objetivo del estudio:
- Informar un caso de OMFR en un niño con psoriasis asociada, enfatizando el papel diagnóstico de la distrofia ungueal.
- Destacar la importancia de reconocer la OMFR dentro del espectro de la enfermedad psoriásica en pacientes pediátricos.
Principales métodos:
- Reporte de caso de una niña de nueve años con dolor en la cadera y la articulación esternoclavicular y cojera.
- El estudio diagnóstico incluyó pruebas de laboratorio (marcadores inflamatorios, ANA, HLA-B27), imágenes (lesiones óseas multifocales) y biopsia ósea.
- El examen físico reveló uñas de los dedos distróficas (traquioniquia/distrofia de veinte uñas).
Principales resultados:
- Las imágenes confirmaron lesiones óseas inflamatorias multifocales consistentes con OMFR.
- Se identificó distrofia ungueal, lo que llevó al diagnóstico de OMFR asociada con psoriasis.
- El tratamiento con naproxeno, calcitriol tópico y metotrexato resultó en remisión clínica completa y resolución de la distrofia ungueal en 18 meses.
Conclusiones:
- La OMFR puede asociarse con la psoriasis, y los cambios en las uñas sirven como una pista diagnóstica crucial.
- El examen físico exhaustivo es vital para identificar afecciones como la traquioniquia, que puede ser la única manifestación de una enfermedad sistémica subyacente.
- El reconocimiento temprano y el manejo multidisciplinario son clave para resultados favorables en la OMFR pediátrica con afecciones asociadas.
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