Acrometastases ( 2 фото )

A 55-year-old man with metastatic squamous-cell lung cancer presented to the hospital with a 6-week history of pain and swelling of the right great toe and the tip of the right middle finger. He reported no history of gout, trauma, or fever. On physical examination, swelling and erythema of the distal phalanx of the right middle finger (Panel A) and the right great toe (Panel B) were noted. An area of ulceration adjacent to the great toenail was also present. The lesions were firm and tender on palpation. Radiographs of the hands and feet showed destructive lytic lesions that had completely replaced the bone of the distal phalanx of the middle finger (Panel C) and the great toe (Panel D). A diagnosis of acrometastases was made. Acrometastases are a rare type of bone metastases that occur distal to the elbow or knee. Although acrometastases may mimic gout or osteomyelitis on physical examination, plain radiographs aid in making the diagnosis in patients with cancer. Palliative radiotherapy was initiated, but the patient died 3 weeks later from complications of refractory hypercalcemia.
Harriet O’Rourke, M.B., B.S., and Mahesh Iddawela, M.B., B.S., Ph.D.Author
Published July 16, 2025
N Engl J Med 2025;393:289
DOI: 10.1056/NEJMicm2501158
VOL. 393 NO. 3


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