Deep palmo-plantar wart causing extensive bone erosion: Brief report

ALMO-PLANTAR WART CAUSING EXTEN EROSION : BRIEF REPORT S. J. McLOUGHLIN,

ONE

S. J. SHAW, S. TURNER andB. S. SYLVESTER

From the Department of Orthopaedics, Ancoats Hospital, Manchester A case is described in which a deep pahno-planar wart (myrmecia) caused erosion of the under~yin

phalanx. Journal oj’Hand Surgery (British Volume, 1990) 15B: 129-130

The possible causes of a swollen finger with underlying bone destruction are numerous (Lister, 1984). We describe a relatively common lesion, the deep palmoplantar wart, causing extensive underlying bone erosion which to our knowledge has not been described before in the literature. Case report A 62-year-old man presented to the casualty department with a five-year history of swelling of the distal phalanx of his right ring finger, recently exacerbated by a minor blow. The patient was referred to the orthopaedic department where a radiograph of the finger showed erosion of the dorsal cortex of the distal phalanx and generalised softtissue swelling, in keeping with a clinical diagnosis of an implantation dermoid with possible superadded infection (Fi-g. 1).

Fig. !

X-rays showing

was no evidence of infection and bacteriology specimens taken at the time revealed no growth. Histological examination of the lesion revealed the characteristic features of a deep palmo-plantar wart (Lye11 and Miles, 1951; Lever and Schaumberg-Lever, 1983) with folds of abundant eosinophilic keratohyalin and chronic inflammatory cell infiltrate (Fig. 2). The lack of a granular layer, perinuclear vacuolisation and small eosinophilic intranuclear inclusion bodies can be seen at higher magnification (Fig. 3). There was no evidence of malignancy or infection.

Fig. 2

Histological palmo-plantar

appearance wart.

Fig. 3

High power view showing

showing

typicai

features

of a deep

large erosion in distal phalanx

The nail was removed and the finger explored through a curved incision at the base of the nail. A large cavity was found, extending from the base of the terminal phalanx to the mid-portion of the nail; a firm white encapsulated swelling resembling an implantation dermoid was removed intact and the cavity curetted. There VOL. 15-B No. 1 FEBRUARY

!990

intra-nuclear

incius.on

bodies. !29

S. J. McLOUGHLIN,

S. J. SHAW,

Discussion

Deep palmo-plantar warts are often associated with erythema, swelling and tenderness. Although more common on the palms and soles, they can be found on the ends of the fingers or toes. Described histologically as myrmecia (Lye11 and Miles, 1951), meaning “anthills” because of their histological appearance, they arise following infection with the human papilloma virus (HPV) serotype 1. Many causes of swelling of a finger associated with bone destruction have been described, but we could find no report in the English literature of bone erosion associated with a deep palmo-plantar wart.

130

S. TURNER

AND B. S. SYLVESTER

References LEVER, W. F. and SCHAUMBERG-LEVER, G. Histopathology of the Skin, 6thedn. Philadelphia, J. B. Lippincott, 1983: 373-374. LISTER, G. The Hand: Diagnosisand Indications,2nd edn. Edinburgh, Churchill Livingstone 1984: 290-311. LYELL, A. and MILES, J. A. R. (1951). A Study of Inclusion Bodies in Warts. British Medical Journal. 1: 912-915.

Accepted: 24 February Mr. S. J. Davyhulme,

1989 McLaughlin, Department ManchesterM31 3SL

0 1990 The

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Society

for Surgery

of Orthopaedics,

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Hospital,

Moorside

Road,

of the Hand

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