SPR Unknown #54 -- FINAL

Christopher Reilly



Richard Shore


Periosteal reaction rejection transplant complication, 1670

Publication Date: 2010-11-26


Five year old male status post small bowel transplant presents in acute cellular rejection. Pt in PICU, found to have knee swelling and ?effusion. Portable radiographs of the bilateral knees were obtained. Follow-up images were obtained two weeks later.


Extensive periosteal reaction involving the metaphyses and diaphyses of the visualized femur, tibia, and fibula.

Small knee effusions.

No fracture. No underlying focal bone abnormality. No joint space narrowing.

On two week follow-up, the periosteal reaction is denser and more easily appreciated. No other change.


Hypertrophic osteoarthropathy secondary to acute cellular transplant rejection.




Hypertrophic osteoarthropathy (HOA) related to acute rejection is a recently published finding. HOA has previously been linked to inflammatory bowel disease and chronic liver disease. Multiple etiologies are proposed but none have been proven.

Hypertrophic osteoarthropathy (HOA) is defined by the findings of clubbing of the digits, periostitis of the long bones, and arthritis. Recently, this syndrome has been linked to acute cellular rejection episodes in children.


  1. McGuire M et al. Hypertrophic osteoarthropathy in intestinal transplant recipients. Journal of Pediatric Surgery (2010) 45, E19–E22.

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