forme fruste
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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.Haubrich, William S. (1997), Medical Meanings: A Glossary of Word Origins, Philadelphia, Pennsylvania: American College of Physicians, pg 85.
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").Eulenberg, A., (1910), [https://books.google.com/books?id=8EECAAAAYAAJ&dq=%22forme+fruste%22+AND+coin&pg=PA960 "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.
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
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- "Forme fruste keratoconus", as opposed to "frank" keratoconus.{{Cite journal |last1=Ueki |first1=Ryotaro |last2=Maeda |first2=Naoyuki |last3=Fuchihata |first3=Mutsumi |last4=Koh |first4=Shizuka |last5=Kitaoka |first5=Takashi |last6=Nishida |first6=Kohji |date=2014-04-30 |title=Differentiation of forme fruste keratoconus from normal cornea using parameters of corneal tomography, aberration, and biomechanics |url=https://iovs.arvojournals.org/article.aspx?articleid=2269150 |journal=Investigative Ophthalmology & Visual Science |volume=55 |issue=13 |pages=3705 |issn=1552-5783}}
- "Zona fruste", early name for zoster sine herpete (shingles without the rash).{{Cite journal |last=Lewis |first=G. W. |date=1958-08-16 |title=Zoster Sine Herpete |url=https://www.bmj.com/content/2/5093/418 |journal=Br Med J |language=en |volume=2 |issue=5093 |pages=418–421 |doi=10.1136/bmj.2.5093.418 |issn=0007-1447 |pmid=13560886|pmc=2026052 }}
- "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).{{Cite journal |last1=Adams |first1=David H. |last2=Rosenhek |first2=Raphael |last3=Falk |first3=Volkmar |date=2010-07-11 |title=Degenerative mitral valve regurgitation: best practice revolution |journal=European Heart Journal |volume=31 |issue=16 |pages=1958–1966 |doi=10.1093/eurheartj/ehq222 |issn=1522-9645 |pmc=2921508 |pmid=20624767}}
- "Forme fruste cleft lip", also known as microform. This is the stated cause of the scar on actor Joaquin Phoenix's upper lip.{{Cite journal |last1=Thaller |first1=S. R. |last2=Lee |first2=T. J. |date=May 1995 |title=Microform cleft lip associated with a complete cleft palate |url=https://pubmed.ncbi.nlm.nih.gov/7605792 |journal=The Cleft Palate-Craniofacial Journal |volume=32 |issue=3 |pages=247–250 |doi=10.1597/1545-1569_1995_032_0247_mclawa_2.3.co_2 |issn=1055-6656 |pmid=7605792}}{{Cite news |date=2020-01-16 |title=TV host Wendy Williams sorry for mocking Joaquin Phoenix's lip scar |url=https://www.bbc.co.uk/news/entertainment-arts-51133234 |access-date=2025-04-14 |work=BBC News |language=en-GB |quote=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.}}
- "'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.{{Cite journal |last1=Nasser |first1=Mouhamad |last2=Thivolet-Béjui |first2=Françoise |last3=Sève |first3=Pascal |last4=Cottin |first4=Vincent |date=2020-06-01 |title=Lung-limited or lung-dominant variant of eosinophilic granulomatosis with polyangiitis |url=https://www.jaci-inpractice.org/article/S2213-2198(20)30146-X/abstract |journal=The Journal of Allergy and Clinical Immunology: In Practice |language=English |volume=8 |issue=6 |pages=2092–2095 |doi=10.1016/j.jaip.2020.01.058 |issn=2213-2198 |pmid=32061719}}
- "'Forme fruste type of calcaneonavicular coalition", the mildest type of CN coalition before fibrous, cartilaginous, or osseous types.{{Cite journal |last1=Upasani |first1=Vidyadhar V. |last2=Chambers |first2=Reid C. |last3=Mubarak |first3=Scott J. |date=2008-07-02 |title=Analysis of calcaneonavicular coalitions using multi-planar three-dimensional computed tomography |journal=Journal of Children's Orthopaedics |volume=2 |issue=4 |pages=301–307 |doi=10.1007/s11832-008-0111-3 |issn=1863-2521 |pmc=2656822 |pmid=19308558}}
- "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.{{Cite journal |last1=Shimotakahara |first1=Akihiro |last2=Yamataka |first2=Atsuyuki |last3=Kobayashi |first3=Hiroyuki |last4=Okada |first4=Yasuhiro |last5=Yanai |first5=Toshihiro |last6=Lane |first6=Geoffrey J |last7=Miyano |first7=Takeshi |date=2003-12-01 |title=Forme fruste choledochal cyst: long-term follow-up with special reference to surgical technique |url=https://www.sciencedirect.com/science/article/abs/pii/S0022346803006249 |journal=Journal of Pediatric Surgery |volume=38 |issue=12 |pages=1833–1836 |doi=10.1016/j.jpedsurg.2003.08.026 |pmid=14666480 |issn=0022-3468}}
- "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.{{cite book|authorlink=Huda Zoghbi|last=Zoghbi|first=Huda Y.|title=The Story of Rett Syndrome: From Clinic to Neurobiology|year=2007|publisher=Cell Press|url=http://ac.els-cdn.com/S0896627307007568/1-s2.0-S0896627307007568-main.pdf?_tid=f8e8d8b47fae7d2941b9b3f05edf1553&acdnat=1335101224_91c30fe7a68f3633df00258c94c0c142|archive-url=https://archive.today/20120707043040/http://ac.els-cdn.com/S0896627307007568/1-s2.0-S0896627307007568-main.pdf?_tid=f8e8d8b47fae7d2941b9b3f05edf1553&acdnat=1335101224_91c30fe7a68f3633df00258c94c0c142|url-status=dead|archive-date=2012-07-07}}{{cite journal|last=Zappella|first=M|title=Preserved speech variants of the Rett syndrome: molecular and clinical analysis|journal=American Journal of Medical Genetics|year=2001|volume=104|issue=1|pages=14–22|doi=10.1002/ajmg.10005|pmid=11746022|display-authors=etal}}
- "Unilateral papillary cystadenoma" is suggested to be a forme fruste of Von Hippel-Lindau disease.{{Cite journal |last=Bahmad |first=Hisham |date=1985-01-01 |title=Papillary Cystadenoma of the Epididymis |url=https://www.academia.edu/104673906 |journal=British Journal of Urology}}
- "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.{{Cite web |last1=Greenfield Jr |first1=L. John |last2=Lee |first2=Sang-Hun |date=2021-05-10 |title=Pathophysiology of Epileptiform Activity |url=https://neupsykey.com/pathophysiology-of-epileptiform-activity/ |access-date=2025-04-14 |website=Neupsy Key |language=en-US}}
- "Forme fruste lupus", incipient, or hidden form, lupus. Seropositivity without clinical findings.{{Cite journal |last1=Chen |first1=Wei-Liang |last2=Tsao |first2=Yu-Tzu |date=2009-10-07 |title=Protein-losing enteropathy with mesenteric venous thrombosis: a forme fruste of systemic lupus erythematosus |url=https://pubmed.ncbi.nlm.nih.gov/19812125 |journal=Lupus |volume=18 |issue=14 |pages=1331–1333 |doi=10.1177/0961203309106182 |issn=1477-0962 |pmid=19812125}}{{Cite web |last1=Leiber |first1=Sarah B. |last2=Lockshin |first2=Michael D. |date=2022-07-27 |title=Lupus Diagnosis and Uncertainties in Chronic Disease {{!}} HSS |url=https://www.hss.edu/conditions_dealing-with-uncertainty-lupus-diagnosis.asp |access-date=2025-04-14 |website=Hospital for Special Surgery |language=en}}
- "Forme fruste tuberous sclerosis", a reduced phenotypic expression of tuberous sclerosis.{{Cite journal |last1=Engel |first1=Sarah G. K. |last2=Bhatia |first2=Sonal |date=2018 |title=Tip of the Iceberg: Forme Fruste Tuberous Sclerosis in a Child |journal=Journal of Pediatric Neurosciences |volume=13 |issue=2 |pages=195–197 |doi=10.4103/jpn.JPN_165_17 |doi-access=free |issn=1817-1745 |pmc=6057210 |pmid=30090134}}{{Cite journal |last1=Thelmo |first1=William L. |last2=Lefkowitz |first2=Martin |last3=Seemayer |first3=Thomas A. |date=1978-04-01 |title=Renal failure secondary to angiomyolipoma case of forme-fruste tuberous sclerosis |url=https://www.sciencedirect.com/science/article/abs/pii/009042957890239X |journal=Urology |volume=11 |issue=4 |pages=389–392 |doi=10.1016/0090-4295(78)90239-X |pmid=664146 |issn=0090-4295}}
- "Forme fruste Charcot-Marie-Tooth disease", manifests as pes cavus and absent ankle jerks only.{{Cite journal |last1=SYMONDS |first1=C. P. |last2=SHAW |first2=M. E. |date=1926-09-01 |title=FAMILIAL CLAW-FOOT WITH ABSENT TENDON-JERKS: A "FORME FRUSTE" OF THE CHARCOT-MARIE-TOOTH DISEASE |url=https://academic.oup.com/brain/article-abstract/49/3/387/294274 |journal=Brain |volume=49 |issue=3 |pages=387–403 |doi=10.1093/brain/49.3.387 |issn=0006-8950}}
- "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.{{Cite web |last=Yost |first=Hunter |date=2023-06-06 |title=Cyclothymia, the Quintessential Mood Temperament: Ignored or Forgotten? Part I: An Overview |url=https://www.psychiatrictimes.com/view/cyclothymia-the-quintessential-mood-temperament-ignored-or-forgotten-part-i-an-overview |access-date=2025-04-14 |website=Psychiatric Times |language=en}}
- "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."{{Cite journal |last=Jablensky |first=Assen |date=2010 |title=The diagnostic concept of schizophrenia: its history, evolution, and future prospects |journal=Dialogues in Clinical Neuroscience |volume=12 |issue=3 |pages=271–287 |doi=10.31887/DCNS.2010.12.3/ajablensky |issn=1294-8322 |pmc=3181977 |pmid=20954425}}
- "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.{{Cite journal |last=Mieszczak |first=Jakub |last2=Eugster |first2=Erica A. |date=August 2007 |title=Treatment of precocious puberty in McCune-Albright syndrome |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC4118734/ |journal=Pediatric Endocrinology Reviews |volume=4 Suppl 4 |issue=0 4 |pages=419–422 |issn=1565-4753 |pmc=4118734 |pmid=17982389}}
- "Forme fruste long-QT syndrome", a congenital LQTS which only appears when an additional stress occurs.{{Cite web |last=de Noronha |first=Denise |last2=Maurício |first2=Sandra |last3=Rodrigues |first3=Idalina |date=2021-06-08 |title=Long QT Syndrome and Anaesthesia |url=https://resources.wfsahq.org/atotw/long-qt-syndrome-and-anaesthesia/ |access-date=2025-04-14 |website=WFSA Resource Library |language=en-US}}
- "Forme fruste pseudoxanthoma elasticum", a variant of pseudoxanthoma elasticum with limited symptoms.{{Cite web |last=Terry |first=Sharon F |last2=Uitto |first2=Jouni |title=Pseudoxanthoma elasticum, forme fruste |url=https://www.ncbi.nlm.nih.gov/gtr/conditions/C1867450/ |access-date=2025-04-14 |website=www.ncbi.nlm.nih.gov}}
See also
References
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