Abstract
Onycophagia, or nail-biting, is common in adults and children, but self-mutilating onycophagia is almost exclusively associated with nerve injury and psychiatric comorbidities, and may lead to osteomyelitis and flexor tenosynovitis. Cases with autophagy or autocannabalistic components are extremely rare, as are cases requiring proximal amputation. Behavioral interventions are rarely successful, but the literature supports psychiatric medication to decrease the onycophagic impulse. We therefore present a 70-year-old male with history of severe onycophagia, diabetic neuropathy, and vascular disease who developed sepsis from onycophagia-associated severe flexor tenosynovitis. He was found to have osteomyelitis of multiple digits and a large abscess extending through nearly every bursa of the hand and forearm, causing forearm compartment syndrome. After surgical treatment and antibiotic therapy, he returned for soft tissue infection and osteomyelitis of the opposite hand, again from severe onycophagia. He was definitively treated, diagnosed with obsessive-compulsive disorder by psychiatry specialists, and was started on medications to reduce onycophagia impulses. He unfortunately relapsed and required further amputation.