1
|
Raimbeau A, Pistorius MA, Goueffic Y, Connault J, Plissonneau-Duquene P, Maurel B, Reignier J, Asehnoune K, Artifoni M, Didier Q, Gautier G, Trochu JN, Rozec B, N’Gohou C, Durant C, Pottier P, Denis Le Sève J, Brebion N, Agard C, Espitia O. Digital ischaemia aetiologies and mid-term follow-up: A cohort study of 323 patients. Medicine (Baltimore) 2021; 100:e25659. [PMID: 34011027 PMCID: PMC8136985 DOI: 10.1097/md.0000000000025659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/05/2021] [Indexed: 12/30/2022] Open
Abstract
Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.
Collapse
Affiliation(s)
| | | | - Yann Goueffic
- Department of Vascular Surgery, University Hospital of Nantes
| | | | | | - Blandine Maurel
- Department of Vascular Surgery, University Hospital of Nantes
| | | | | | | | | | | | | | | | - Chan N’Gohou
- Department of Medical Data Processing, University Hospital of Nantes
| | | | | | | | - Nicolas Brebion
- Department of Vascular Medicine, Hospital of La Roche sur Yon, France
| | | | | |
Collapse
|
2
|
Chatterjee S, Pauling JD. Anti-phospholipid syndrome leading to digital ischaemia and rare organ complications in systemic sclerosis and related disorders. Clin Rheumatol 2020; 40:2457-2465. [PMID: 32959188 DOI: 10.1007/s10067-020-05399-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 11/27/2022]
Abstract
Antiphospholipid syndrome (APS) is an acquired, autoimmune thrombophilia that can occur as a primary disorder (with no associated disease) or secondary to infection, medication usage and autoimmune rheumatic diseases (ARDs). The association between APS and systemic lupus erythematosus (SLE) is well established, and practicing rheumatologists check for APS antibodies in the routine assessment of SLE, particularly if clinical features such as thrombotic events or pregnancy loss are present. APS secondary to systemic sclerosis (SSc)-related disorders is less widely recognised and easily overlooked. We describe 5 cases that highlight the varied breadth of clinical manifestations of APS in the context of SSc and related disorders. These cases range from uncomplicated Raynaud's phenomenon, digital ulceration/necrosis, critical digital ischaemia/gangrene and rare internal organ complications of APS in SSc-spectrum disorders. To our knowledge, our cases include the first reported case of secondary APS contributing to digital necrosis in the context of RACAND syndrome (Raynaud's phenomenon, anti-centromere antibodies and necrosis of the digits) and the first reported case of secondary APS in SSc causing posterior reversible encephalopathy syndrome (PRES). The case series is accompanied by a comprehensive review of the literature relevant to each case. Rheumatologists should be alert to the possibility of APS in SSc-spectrum disorders and should routinely check APS antibodies in all patients at diagnosis, and again later in the disease course if new features emerge that could indicate the presence of thrombotic events or other recognised APS manifestations. Key points • APS should be considered in all patients with digital ischaemic symptoms. • APS may be an important driver of SSc-related digital ulceration/necrosis. • Identification of SSc-associated APS opens up new therapeutic options for acute management and secondary prevention.
Collapse
Affiliation(s)
- Saion Chatterjee
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK. .,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
| |
Collapse
|
3
|
Klejtman T, Garel B, Senet P, Tribout L, Bachmeyer C, Barbaud A, Monfort JB. [Digital necrosis revealing cold agglutinin disease: Treatment with rituximab]. Ann Dermatol Venereol 2018; 145:761-764. [PMID: 30197053 DOI: 10.1016/j.annder.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/11/2017] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Digital necrosis is rarer than lower limb necrosis and constitutes a medical or surgical emergency. Etiological evaluation is required. Cold agglutinin disease is a cause of digital necrosis but diagnosis is difficult. PATIENTS AND METHODS Herein we report the case of a 57-year-old man presenting recent paroxysmal acrosyndrome of the left hand subsequently complicated by digital necrosis following occupational exposure to cold in his work as a forklift driver. After etiological evaluation, a diagnosis of primary cold agglutinin disease was made. Intravenous rituximab and topical treatment resulted in complete healing. DISCUSSION Cold agglutinin disease is a rare type of auto-immune hemolytic anemia. Following exposure to cold, paroxysmal cutaneous signs are frequent. The disease may be either primary or secondary with B-cell lymphoproliferative disorder, auto-immune disease or infection. A thorough workup is required. To date, the treatment combining the best positive response rate and good safety is rituximab in weekly perfusions over a 1-month period.
Collapse
Affiliation(s)
- T Klejtman
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - B Garel
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P Senet
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - L Tribout
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Bachmeyer
- Service de médecine interne, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - A Barbaud
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J-B Monfort
- Service de dermatologie et allergologie, université Pierre-et-Marie-Curie, Paris VI, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| |
Collapse
|