RT Book, Section A1 Shah, Ashish A1 Sobolewski, Brad A1 Mittiga, Matthew R. A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181044607 T1 Dactylitis (Hand-Foot Syndrome) T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181044607 RD 2024/10/10 AB This painful vaso-occlusive condition is commonly the 1st clinical manifestation of sickle cell disease in infants. It usually presents in children younger than 5 years of age, with nearly 45% of first cases presenting prior to the age of 2. Patients are acutely ill with fever, leukocytosis, and swollen hands and/or feet that are exquisitely painful due to bone infarction. Some children may present with fussiness and swelling with minimal erythema or fever. X-rays are often normal, and it is not until 1 to 2 weeks later that subperiosteal new bone, cortical thickening, and even complete bone destruction can be seen. The differential diagnosis includes osteomyelitis, trauma, cold injuries, acute rheumatic fever, juvenile rheumatoid arthritis, and leukemia.