Forme fruste

In medicine, a forme fruste (French, "crude, or unfinished, form"; pl., formes frustes) is an atypical or attenuated manifestation of a disease or syndrome, with the implications of incompleteness, partial presence or aborted state. The context is usually one of a well defined clinical or pathological entity, which the case at hand almost — but not quite — fits.

An opposite term in medicine, forme pleine — seldom used by English-speaking physicians — means the complete, or full-blown, form of a disease.

Use

According to gastroenterologist William Haubrich:

A patient may exhibit sudden, intense, epigastric pain and a rigid abdomen. He is thought to have a perforated peptic ulcer. But at operation, only a penetrating ulcer is found, sealed off by adhesion to the omentum or anterior abdominal wall. Such a patient is said to have a forme fruste of acute free perforation as a complication of his peptic ulcer disease. ^[1]

History

The Latin phrase frustra esse means "to be mistaken" or "to be confused". As a technical term in French, the cognate fruste has been used in two related ways. First, as an antiquarian’s term it refers to a coin, medal or ancient stone on which figures and characters can no longer be recognized due to wear. Secondly, it was employed in natural history to denote mollusk shells whose striations, grooves or tips were worn down. By extension, this sense could be applied to sculpture, pottery, or other objects of great antiquity.

It was in this sense of "indistinctness due to wear or through long use" that the French internist Armand Trousseau (1801–67) first employed the term in connection with an obscured form of Graves' disease, which he described as a "…maladie dite fruste par l’absence du goitre et de l’exophthalmie" ("…disease said to be crude [i.e., indistinct] for its absence of goiter and exophthalmia"). ^[2]

The term in medicine has evolved to mean a "not fully developed form of an illness", rather than simply an obscure form. Sigmund Freud (1856–1939) often used the term forme fruste in connection with incomplete or obscured cases of neuroses and psychoses and thus the literature of psychoanalysis is replete with it. (An equivalent term in German is minimalvariante, but Freud used the French version.)

List of "forme fruste" medical syndromes

• "Forme fruste keratoconus", as opposed to "frank" keratoconus. ^[3]
• "Zona fruste", early name for zoster sine herpete (shingles without the rash). ^[4]
• "Forme fruste mitral regurgitation", mitral regurgitation due to fibroelastic deficiency with myxomatous changes (as opposed to fully formed degenerative changes seen in Barlow's disease). ^[5]
• "Forme fruste cleft lip", also known as microform. This is the stated cause of the scar on actor Joaquin Phoenix's upper lip. ^{[6] [7]}
• "'Formes frustes of eosinophilic granulomatosis with polyangiitis" have also been described as eosinophilic vasculitis and/or eosinophilic granulomas in isolated organs without evidence of systemic disease. ^[8]
• "'Forme fruste type of calcaneonavicular coalition", the mildest type of CN coalition before fibrous, cartilaginous, or osseous types. ^[9]
• "Forme fruste choledochal cyst", a variant of choledochal cyst described in children in which there is an Anomalous Pancreaticobiliary Ductal Junction (APBDJ) with minimal dilatation of bile duct (6-10mm) in children and associated biliary and/ or pancreatic symptoms. The preferred treatment is bile duct excision. The reason for surgery is the significant risk of malignancy and for symptomatic relief. ^[10]
• "Forme fruste Rett Syndrome", variant of Rett Syndrome which has a later age of onset compared with the classical form, with regression occurring between 1 and 3 years of age; hand use is sometimes preserved with minimal stereotypic movements. ^{[11] [12]}
• "Unilateral papillary cystadenoma" is suggested to be a forme fruste of Von Hippel-Lindau disease. ^[13]
• "Forme fruste of an epileptiform discharge", an EEG abnormality which appears similar to an epileptiform discharge but with a poorly-defined or nonstereotypic morphology, or with a more limited or fragmented cephalic distribution. This abnormality may represent a discharge that is less well-formed due to treatment with medications or may be seen as an age-limited epilepsy syndrome. ^[14]
• "Forme fruste lupus", incipient, or hidden form, lupus. Seropositivity without clinical findings. ^{[15] [16]}
• "Forme fruste tuberous sclerosis", a reduced phenotypic expression of tuberous sclerosis. ^{[17] [18]}
• "Forme fruste Charcot-Marie-Tooth disease", manifests as pes cavus and absent ankle jerks only. ^[19]
• "Forme fruste bipolar disorder" (cyclothymia), a variant of bipolar disorder characterised by regularly alternating periods of both heightened and depressed mood, neither of which meet the full criteria for mania, hypomania, or depression. ^[20]
• "Forme fruste schizophrenia forms" (paranoid and schizotypal personality disorders) - Cluster A personality disorders which represent an accentuated variant of the whole schizophrenic process (schizotypal personality disorder) or the paranoid subtype specifically (paranoid personality disorder). Schizoid personality disorder, the third Cluster A personality disorder, is often also considered a "schizophrenia spectrum disorder." ^[21]
• "Forme fruste McCune-Albright syndrome". McCune-Albright syndrome is typically a triad of precocious puberty, café au lait spots and fibrous dysplasia of bone. Some children present with a forme fruste variant with only one clinical feature. ^[22]
• "Forme fruste long-QT syndrome", a congenital LQTS which only appears when an additional stress occurs. ^[23]
• "Forme fruste pseudoxanthoma elasticum", a variant of pseudoxanthoma elasticum with limited symptoms. ^[24]

See also

• Cryptogenic
• Diagnosis of exclusion

References

1. Haubrich, William S. (1997), Medical Meanings: A Glossary of Word Origins, Philadelphia, Pennsylvania: American College of Physicians, pg 85.
2. Eulenberg, A., (1910), "The Present Status of Graves' Disease (Exophthalmic Goiter. Basedow’s Disease)"; In: Church, Archibald, editor (1910), Diseases of the Nervous System (Series: Modern Clinical Medicine); Translation of German original; New York City and London: D. Appleton and Company, pp 961-962.
3. Ueki, Ryotaro; Maeda, Naoyuki; Fuchihata, Mutsumi; Koh, Shizuka; Kitaoka, Takashi; Nishida, Kohji (2014-04-30). "Differentiation of forme fruste keratoconus from normal cornea using parameters of corneal tomography, aberration, and biomechanics". Investigative Ophthalmology & Visual Science. 55 (13): 3705. ISSN   1552-5783.
4. Lewis, G. W. (1958-08-16). "Zoster Sine Herpete". Br Med J. 2 (5093): 418–421. doi:10.1136/bmj.2.5093.418. ISSN   0007-1447. PMC   2026052 . PMID   13560886.
5. Adams, David H.; Rosenhek, Raphael; Falk, Volkmar (2010-07-11). "Degenerative mitral valve regurgitation: best practice revolution". European Heart Journal. 31 (16): 1958–1966. doi:10.1093/eurheartj/ehq222. ISSN   1522-9645. PMC   2921508 . PMID   20624767.
6. Thaller, S. R.; Lee, T. J. (May 1995). "Microform cleft lip associated with a complete cleft palate". The Cleft Palate-Craniofacial Journal. 32 (3): 247–250. doi:10.1597/1545-1569_1995_032_0247_mclawa_2.3.co_2. ISSN   1055-6656. PMID   7605792.
7. "TV host Wendy Williams sorry for mocking Joaquin Phoenix's lip scar". BBC News. 2020-01-16. Retrieved 2025-04-14. Phoenix has rarely spoken about his condition, but it is thought to be a microform cleft, which is a mild form of cleft lip that looks like a scar.
8. Nasser, Mouhamad; Thivolet-Béjui, Françoise; Sève, Pascal; Cottin, Vincent (2020-06-01). "Lung-limited or lung-dominant variant of eosinophilic granulomatosis with polyangiitis". The Journal of Allergy and Clinical Immunology: In Practice. 8 (6): 2092–2095. doi: 10.1016/j.jaip.2020.01.058 . ISSN   2213-2198. PMID   32061719.
9. Upasani, Vidyadhar V.; Chambers, Reid C.; Mubarak, Scott J. (2008-07-02). "Analysis of calcaneonavicular coalitions using multi-planar three-dimensional computed tomography". Journal of Children's Orthopaedics. 2 (4): 301–307. doi:10.1007/s11832-008-0111-3. ISSN   1863-2521. PMC   2656822 . PMID   19308558.
10. Shimotakahara, Akihiro; Yamataka, Atsuyuki; Kobayashi, Hiroyuki; Okada, Yasuhiro; Yanai, Toshihiro; Lane, Geoffrey J; Miyano, Takeshi (2003-12-01). "Forme fruste choledochal cyst: long-term follow-up with special reference to surgical technique" . Journal of Pediatric Surgery. 38 (12): 1833–1836. doi:10.1016/j.jpedsurg.2003.08.026. ISSN   0022-3468. PMID   14666480.
11. Zoghbi, Huda Y. (2007). The Story of Rett Syndrome: From Clinic to Neurobiology (PDF). Cell Press. Archived from the original (PDF) on 2012-07-07.
12. Zappella, M; et al. (2001). "Preserved speech variants of the Rett syndrome: molecular and clinical analysis". American Journal of Medical Genetics. 104 (1): 14–22. doi:10.1002/ajmg.10005. PMID   11746022.
13. Bahmad, Hisham (1985-01-01). "Papillary Cystadenoma of the Epididymis". British Journal of Urology.
14. Greenfield Jr, L. John; Lee, Sang-Hun (2021-05-10). "Pathophysiology of Epileptiform Activity". Neupsy Key. Retrieved 2025-04-14.
15. Chen, Wei-Liang; Tsao, Yu-Tzu (2009-10-07). "Protein-losing enteropathy with mesenteric venous thrombosis: a forme fruste of systemic lupus erythematosus". Lupus. 18 (14): 1331–1333. doi:10.1177/0961203309106182. ISSN   1477-0962. PMID   19812125.
16. Leiber, Sarah B.; Lockshin, Michael D. (2022-07-27). "Lupus Diagnosis and Uncertainties in Chronic Disease | HSS". Hospital for Special Surgery. Retrieved 2025-04-14.
17. Engel, Sarah G. K.; Bhatia, Sonal (2018). "Tip of the Iceberg: Forme Fruste Tuberous Sclerosis in a Child". Journal of Pediatric Neurosciences. 13 (2): 195–197. doi: 10.4103/jpn.JPN_165_17 . ISSN   1817-1745. PMC   6057210 . PMID   30090134.
18. Thelmo, William L.; Lefkowitz, Martin; Seemayer, Thomas A. (1978-04-01). "Renal failure secondary to angiomyolipoma case of forme-fruste tuberous sclerosis" . Urology. 11 (4): 389–392. doi:10.1016/0090-4295(78)90239-X. ISSN   0090-4295. PMID   664146.
19. SYMONDS, C. P.; SHAW, M. E. (1926-09-01). "Familial Claw-Foot with Absent Tendon-Jerks: A "Forme Fruste" of the Charcot-Marie-Tooth Disease" . Brain. 49 (3): 387–403. doi:10.1093/brain/49.3.387. ISSN   0006-8950.
20. Yost, Hunter (2023-06-06). "Cyclothymia, the Quintessential Mood Temperament: Ignored or Forgotten? Part I: An Overview". Psychiatric Times. Retrieved 2025-04-14.
21. Jablensky, Assen (2010). "The diagnostic concept of schizophrenia: its history, evolution, and future prospects". Dialogues in Clinical Neuroscience. 12 (3): 271–287. doi:10.31887/DCNS.2010.12.3/ajablensky. ISSN   1294-8322. PMC   3181977 . PMID   20954425.
22. Mieszczak, Jakub; Eugster, Erica A. (August 2007). "Treatment of precocious puberty in McCune-Albright syndrome". Pediatric Endocrinology Reviews. 4 Suppl 4 (4): 419–422. ISSN   1565-4753. PMC   4118734 . PMID   17982389.
23. de Noronha, Denise; Maurício, Sandra; Rodrigues, Idalina (2021-06-08). "Long QT Syndrome and Anaesthesia". WFSA Resource Library. Retrieved 2025-04-14.
24. Terry, Sharon F; Uitto, Jouni. "Pseudoxanthoma elasticum, forme fruste". www.ncbi.nlm.nih.gov. Retrieved 2025-04-14.