Higher Education | Medicine and Health Sciences | Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
Raynaud’s disease is a cutaneous manifestation often present in various connective tissue and vascular diseases. Depending on the age of onset and acuity of symptoms, the phenomenon can provide clinicians with some insight as to the severity of underlying disease, including the distinction between primary and secondary Raynaud’s. However, this diagnostic approach seems to have its limitations regarding efficacy and timing of treatment. Traditionally, treatment of Raynaud’s has focused on reestablishing blood perfusion to affected tissue, which has previously been achieved with vasodilatory medications and site-specific surgical intervention. In lieu of the severe sequelae of Raynaud’s in the setting of mixed connective tissue disease, including autoamputation, preemptive treatment of Raynaud’s should be considered, as distinguishing between a primary and secondary etiology of Raynaud’s can often be difficult to discern. This case highlights the importance of conventional salvage therapies prior to establishing a definitive diagnosis or etiology of the phenomenon, as evidenced by our patient experiencing irreversible ischemic damage resulting in uncontrolled autoamputation of her digits.
Mixed connective tissue disease; auto-amputation; ischemia; Raynaud's disease; thromboangiitis obliterans
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Patel, K. P., Medlin, J. L., , Hearth-Holmes, M. Multi-digit Auto-amputation in Setting of Mixed Connective Tissue Disease. Graduate Medical Education Research Journal. 2020 Dec 09; 2(2).
Bilateral hands with distal digit ulceration and cyanotic changes
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Bilateral hands with chronic osteomyelitic changes post-surgical intervention (dorsal aspect of hands)
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Bilateral hands with chronic osteomyelitic changes post-surgical intervention (palmar aspect of hands)