Haemophilic Pseudotumor a rare differential for swelling of the great toe A case report.

Abstract

Haemophilic pseudotumor is a rare complication in haemophiliacs with high recurrence rates. Involvement of the bones prone for trauma is common. Early surgical                   intervention with adequate factor cover proves beneficial in these patients. An 18-year old male with haemophilia A (negative for factor VIII inhibitor assay), presented with a swelling of the left great toe, one year following trauma. It was diagnosed to be a pseudotumor of the left first distal phalanx based on clinical and radiological findings. Amputation of the great toe at the level of first inter-phalangeal joint was           performed under factor cover. Post operatively, he was found to have a positive factor VIII inhibitor assay, which warranted increased factor VIII transfusions. 2 years following this, the patient presented with one month history of rapidly increasing swelling of the left great toe. It was a recurrence. 1st ray  amputation was performed under factor cover with no post-op complications. This case reinforces that pseudotumor should be considered as one of the differentials for expansile lytic lesions of small bones in the background of haemophilia and suggests close follow up of patients with positive inhibitor assay, considering the high recurrence rate in such patients and the invasiveness of the condition.