https://orcid.org/0000-0002-8970-6741
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Liliana A Saraiva, Rita N Cunha, Marlene P Sousa, Pedro Abreu, Maria J Salvador, Critical digital ischaemia—a rare complication of systemic sclerosis, Rheumatology, Volume 59, Issue 6, June 2020, Page 1334, https://doi.org/10.1093/rheumatology/kez507
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We report a case of a 74-year-old female with limited cutaneous SSc with positive anti-nuclear and anti-centromere antibodies, and 6 years of disease duration. She had a previous history of RP, telangiectasia, recurrent digital ulcers and previous amputations of second left, third and fourth right fingers. At admission, she presented digital gangrene with a week of evolution that progressed to critical digital ischaemia of her third left finger associated with excruciating pain, refractory to analgesics (Fig. 1). She started iloprost and antibiotics to prevent overinfection. Despite these measures, the finger lesion progressed, leading to the inflammation of surrounding tissues, compromised blood flow and amputation. This serious complication of SSc, previously described in the literature, frequently has an irreversible progression [1]. Marvi and Chung reported an estimated incidence to multiple digit loss of 9.2% and a more recent cohort reported that 43% of patients with SSc experience at least one episode of severe digital ischaemia [2]. The same review describes an association between patients with positive anti-centromere antibody and amputation (odds ratio: 3.12) [2]. More studies need to be done in this field to optimized and prevent these critical events.
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