Intra-articular injected hyaluronic acid provides pain relief and functional improvements in patients with gonarthrosis. We present a 92-year-old woman with iatrogenic blue toe syndrome after intra-articular injection of hyaluronic acid. This is an anecdotally rare complication, which aims to heighten the clinician`s awareness on the possible intervention pitfalls and spectrum of therapeutic indications.
Bennell KL, Hunter DJ, Hincan RS. Management of osteoarthritis of the knee. BMJ. 2012; 345: 4934. doi: 10.1136/bmj.e4934
Schneider U, Miltner O, Graf J, Thomsen M, Niethard FU. Mechanism of action of hyaluronic acid in gonarthrosis of both knee joints in a right/left comparison. Study of dynamometry, oxygen partial pressure, temperature and Lequesne score. Z Orthop Ihre Grenzgeb. 1997; 135(4): 341-7. doi: 10.1055/s-2008-1039399
Kon E, Firaldo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012; 20(3): 436-9. doi: 10.1007/s00167-011-1713-8
Saric M, Kronzon I. Aortic atherosclerosis and embolic events. Curr Cardiol Rep. 2012; 14(3): 342-9. doi: 10.1007/s11886-012-0261-2
Moolenar W, Lamers CBHW. Cholesterol crystal embolism in the Netherlands. Arch Intern Med. 1996;156(6):653-7.
Mayo RR, Swartz RD. Redefining the incidence of clinically detectable atheroembolism. Am J Med. 1996;100(5):524-9.
Robson MG, Scoble JE. Atheroembolic disease. Br J Hosp Med. 1996;55(10):648-52.
Varis J, Kuusniemi K, Heiro M, Javelainen H. Blue toe syndrome – a rare but possible complication of anti-coagulant therapy. Duodecim. 2011; 127(11): 1154-7.
Nakazawa K, Ohta T, Fujimoto M, Imamura H, Hashimoto N. Case report of cholesterol embolism 1 month after carotic stenting. No Shinkei Geka. 2007; 35(8): 807-15.
Heuschmid M, Ketelsen D, Brechtel K. Advanced interventional techniques in the treatment of peripheral artery disease below the knee. Rofo. 2012; 184(7): 607-17. doi: 10.1055/s-0031-1299332
Falanga F, Fine MJ, Kapoor WN. The cutaneous manifestations of cholesterol crystal embolism. Arch Dermatol. 1986; 122(10):1194-8.
Spittell PC, Seward JB, Hallett J. Mobile thrombi in the abdominal aorta in cases of lower extremity embolic arterial occlusion: value of extended transthoracic echocardiography. Am Heart J. 2000; 139(2 Pt 1): 241-4.
Begon E, Bouilly P, Cheysson E, Cohen P, Bachmeyer C. Isolated blue toe syndrome as presenting sign of Wegener granulomatosis. Am J Med. 2010; 123(7): 7-8. doi: 10.1016/j.amjmed.2009.11.024