An infected vascular graft is an uncommon association in hypertrophic osteoarthropathy (
HOA) but is important because of potential catastrophic complications. Here we describe 3 new patients with
HOA secondary to
vascular prosthesis infection and review the other 23 patients described in the English literature with this clinical syndrome. The finding of symptoms and signs of localized
HOA in patients with arterial
prosthesis may be the presenting manifestation of graft
sepsis. In most patients the graft is located at the aorta or aortic bifurcation. The initial symptoms are
fever,
joint pain mainly involving the knees and ankles, clubbing, and in some cases intestinal
bleeding. Recurrent
abscesses and
bacteremia arising in spite of appropriate antimicrobial
therapy are prominent infectious signs. Another characteristic feature is the wide variety of bacteria isolated from a single patient. When a polymicrobial enteric flora is isolated from the blood or other tissue, an intestinal origin of
infection can be readily suspected.
Gallium or leukocyte scans are useful for detecting an
abscess around the
vascular prosthesis. In some cases, the detection of gas around the graft demonstrated by computed tomography is highly suggestive of
prosthesis infection. Mechanisms involved in the pathogenesis of
HOA associated with aortic graft
infection are unknown. Treatment consists of intravenous
antibiotics and surgical replacement of the infected graft. The prognosis of arterial
prosthesis infection depends greatly on early diagnosis and treatment before the onset of life-threatening complications. Knowledge of this rare association may lead to an early diagnosis and appropriate management of this serious and often fatal complication.