1
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Aboujabal K, Sadek K, Obaid K, Sawaf B, Habas E, Habib MB. Iron deficiency-induced thrombocytosis presenting with blue toe syndrome. Clin Case Rep 2024; 12:e8596. [PMID: 38571904 PMCID: PMC10988659 DOI: 10.1002/ccr3.8596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Although the etiology of blue toe syndrome is varied, the association between blue toe syndrome and iron deficiency-induced thrombocytosis (IDIT) has not been well established. We report the case of a 38-year-old Saudi male who presented with blue toe syndrome and laboratory investigations revealed severe thrombocytosis secondary to iron deficiency. The patient was managed with analgesics, antiplatelets, anticoagulation, intravenous fluids, and iron supplementation. Subsequently, his symptoms resolved within a few days. IDIT is crucial to consider as a possible cause of microvascular thrombosis disorders, especially in patients with severe thrombocytosis.
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Affiliation(s)
- Khaled Aboujabal
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Khaled Sadek
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Koutaibah Obaid
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Bisher Sawaf
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Elmukhtar Habas
- Department of Internal MedicineHamad Medical CorporationDohaQatar
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2
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Cardoso PSR, da Silva CBPG, de Abreu ES, Oliveira AG, Pereira IFDM, Navarro TP, Rezende SM. Blue toe syndrome, severe haemophilia A and emicizumab. Haemophilia 2024; 30:241-244. [PMID: 37870891 DOI: 10.1111/hae.14893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Patrícia Santos Resende Cardoso
- Hematology and Oncology Unit, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hematology, HEMOMINAS Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | - Eliabe Silva de Abreu
- Haemostasis and Thrombosis Study Group, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Túlio Pinho Navarro
- Department of Surgery, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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3
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van den Beukel BAW, Poot A, Beuk R. Fatal Course of Cutaneous Cholesterol Embolization Syndrome: A Case Report. INT J LOW EXTR WOUND 2023; 22:753-758. [PMID: 34791924 DOI: 10.1177/15347346211058590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cholesterol embolization syndrome is an increasing but underestimated problem after endovascular intervention or after the start of thrombolytic therapies. Embolies from the aortic wall involves abdominal organs and the skin of the lower extremities or buttocks. In our case a progressive ulceration and necroses occurs spontaneously. Endovascular treatment of the lower extremities was successful for a short period. Due to the progression of necrosis, both legs were amputated. Biopsies were taken from the skin were initially no directions to the diagnosis of Cholesterol embolization syndrome. After a second elliptical excision biopsy the diagnosis of cholesterol embolization syndrome was confirmed. Because the rapid progression of skin necroses despite the treatment of prednisone, patient died due to sepsis and renal failure. This case shows when arterial revascularization is performed and progression in skin necrosis occurs despite optimal arterial vascular status the diagnosis CES should be considered and treated in an early state of disease.
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Affiliation(s)
| | - A Poot
- Medisch Spectrum Twente, Netherlands
| | - R Beuk
- Medisch Spectrum Twente, Netherlands
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4
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Mostafa K, Wolf C, Bürger M, Kapahnke S, Michaelis T, Berndt R, Rusch R, Andersson J, Schäfer PJ. Functional bony entrapment of the dorsalis pedis artery caused by cranial subluxation in the talonavicular joint. CVIR Endovasc 2023; 6:57. [PMID: 38019379 PMCID: PMC10686910 DOI: 10.1186/s42155-023-00410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
A 66-year-old female presented in the emergency department with Blue-Toe-Syndrome (BTS) and signs of osteitis of her left big toe. Imaging workup of the peripheral vasculature showed no findings. Upon invasive angiography, severe focal stenosis of the dorsalis pedis artery (DPA) could be seen at the talonavicular joint. Complete regression of the stenosis was inducible by dorsal extension in the ankle joint. Further imaging revealed an underlying subluxation of the talonavicular joint as cause of the arterial compression. Entrapment of the DPA is a rare condition and most often described in relation to connective tissue bands or variant muscular tendons (McCabe et al. 70:213-8, 2021; Weichman et al. 24:113, 2010; Smith et al.58:212-4, 2013; Griffin et al. 20:325-8; 2012). In the presented case, bony compression of the PDA due to cranial subluxation of the talus was seen as the cause of BTS and osteitis of the phalanx of the first toe.
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Affiliation(s)
- Karim Mostafa
- Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
| | - Carmen Wolf
- Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Bürger
- Clinic of Cardiovascular Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Kapahnke
- Clinic of Cardiovascular Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Thorben Michaelis
- Clinic of Cardiovascular Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Rouven Berndt
- Clinic of Cardiovascular Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Rene Rusch
- Clinic of Cardiovascular Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Julian Andersson
- Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Philipp Jost Schäfer
- Department for Radiology and Neuroradiology, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
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5
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Suzuki M, Watari T. Blue toe syndrome caused by spontaneous cholesterol embolization syndrome. QJM 2023; 116:936-937. [PMID: 37471693 DOI: 10.1093/qjmed/hcad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- M Suzuki
- Department of General Internal Medicine, National Hospital Organization Sendai Medical Center, Miyagi, Japan
| | - T Watari
- Department of Internal Medicine, University of Michigan Medical School, MI, USA
- General Medicine Centre, Shimane University Hospital, Shimane, Japan
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6
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Kano Y, Shigehara Y. Blue toe syndrome caused by cholesterol crystal embolisation in a patient with warfarin use. BMJ Case Rep 2023; 16:e257927. [PMID: 37798039 PMCID: PMC10565294 DOI: 10.1136/bcr-2023-257927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Affiliation(s)
- Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yohya Shigehara
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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7
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Hochmayr C, Kiechl-Kohlendorfer U, Griesmaier E. COVID toes, newborn blue toes, and prepartum SARS-CoV-2 infection - Authors' reply. Lancet 2023; 402:1132. [PMID: 37777333 DOI: 10.1016/s0140-6736(23)01748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Christoph Hochmayr
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck 6020, Austria
| | | | - Elke Griesmaier
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck 6020, Austria.
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8
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Zhou YB, Xu ZG. COVID toes, newborn blue toes, and prepartum SARS-CoV-2 infection. Lancet 2023; 402:1131-1132. [PMID: 37777330 DOI: 10.1016/s0140-6736(23)01749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/18/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Ya Bin Zhou
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Zi Gang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China.
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9
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Sibai J, Chen R, Nabhani IA, Perusini MA, Sibai H. Foot gangrene following Tagraxofusp treatment for blastic plasmacytoid dendritic cell neoplasm: Case report. EJHAEM 2022; 3:1374-1376. [PMID: 36467820 PMCID: PMC9713045 DOI: 10.1002/jha2.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/30/2022] [Accepted: 07/23/2022] [Indexed: 06/17/2023]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy. It is associated with poor prognosis and heterogenous presentation. The CD123-directed cytotoxin, Tagraxofusp, is a targeted therapy for BPDCN. Here, we report an 81-year-old female diagnosed with BPDCN. The patient was treated with Tagraxofusp and underwent a remarkably long remission (>20 months) without stem-cell transplantation. She, however, experienced blue toe syndrome and left foot gangrene. We postulate that these previously unreported side effects were caused by microembolization. Characterization of the incidence of thrombo- and microembolizations in such a context, as well as prophylactic management options, are warranted.
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Affiliation(s)
- Jad Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
| | - RuiQi Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
| | - Ibrahim Al Nabhani
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
| | - Maria Agustina Perusini
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
| | - Hassan Sibai
- Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity Health NetworkTorontoCanada
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10
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Vignes S, Fourgeaud C, Michon-Pasturel U. Un syndrome des orteils bleus révélant un cancer de la prostate métastatique : une observation avec analyse de la littérature. Rev Med Interne 2022; 43:562-565. [DOI: 10.1016/j.revmed.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/02/2022] [Accepted: 04/09/2022] [Indexed: 11/25/2022]
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Gupta S, Xu D, Hadfield J, Prentice D. Durvalumab-associated vasculitis presenting as 'the blue toe syndrome'. BMJ Case Rep 2020; 13:13/11/e235886. [PMID: 33208309 DOI: 10.1136/bcr-2020-235886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Durvalumab is a selective, high-affinity human immunoglobulin monoclonal antibody in a class called check point inhibitors, that blocks PD-L1 on tumour cells. Despite clinical success in increasing progression-free survival rates in patients with stage III non-small-cell lung cancer, durvalumab has been associated with immune-related side effects such as pneumonitis and colitis. We present a case of an 84-year-old woman with acral vasculitis presenting as blue toe syndrome, associated with prolonged use of durvalumab. After 1 year of fortnightly durvalumab therapy postchemoradiation therapy, the patient came in with a left blue big toe, and later developed bilateral livedo racemosa. The diagnosis of durvalumab-associated vasculitis was made and treatment with prednisolone was started with clinical improvement.
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Affiliation(s)
- Shivangi Gupta
- Curtin Medical School, Faculty of Health Sciences, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Dan Xu
- Curtin Medical School/School of Public Health, Faculty of Health Sciences, Curtin University Bentley Campus, Perth, Western Australia, Australia .,Medical Education, The First Affiliated Hospital, Sun Yan-Sen University, Guangzhou, China
| | - Jane Hadfield
- Internal Medicine, St John of Gods Hospital Midland, Perth, Western Australia, Australia
| | - David Prentice
- Internal Medicine, St John of Gods Hospital Midland, Perth, Western Australia, Australia
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12
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Pradhan S, Gresa K, Röing Genannt Nölke JP, Trappe HJ. Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report. Thromb J 2020; 18:13. [PMID: 32699533 PMCID: PMC7370423 DOI: 10.1186/s12959-020-00226-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022] Open
Abstract
Background Left atrial septal pouches (LASPs) are a relatively newly described but common anatomical cardiac variant thought to be associated with atrial fibrillation (AF) and cardio-embolic stroke. Blue toe syndrome (BTS) describes ischemic changes in the toes due to microembolisation of the digital arteries. Establishing the etiology of BTS is vital so that the underlying cause can be treated. Here we describe the first case of BTS arising due to emboli from LASP thrombus arising on a background of new-onset AF. Case presentation A 65-year-old man presented with a two-day history of progressive painful swelling and bluish-purple discoloration of the second and fourth toes of his left foot and new-onset AF. Tests for hypercoagulability disorders were negative. Duplex ultrasound and CT angiography excluded deep venous thrombosis and an absence of embolus, thrombus, or occlusion in the arterial tree in the lower extremities bilaterally, so BTS was diagnosed. While transthoracic echocardiography and chest CT initially showed no cardiac abnormalities or mural thrombus, subsequent transesophageal echocardiography revealed a LASP with an associated pedunculated thrombus. The affected toes were amputated due to wet gangrene, but the patient recovered well with thrombus resolution after anticoagulation. Conclusion The presence of a LASP in the absence of any other identifiable cause of BTS should trigger careful investigation of the interatrial septum, preferably using a multimodality imaging approach. The possibility that LASPs may not merely be an innocent bystander but a causative mechanism for peripheral ischemia must be considered.
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Affiliation(s)
- Snehasis Pradhan
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625 Herne, Germany
| | - Kciku Gresa
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625 Herne, Germany
| | - Jan-Peter Röing Genannt Nölke
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625 Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology and Angiology, Marien Hospital Herne, Ruhr- University of Bochum, Hoelkeskampring 40, 44625 Herne, Germany
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13
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Multiple Myeloma Mimicking a Small Vessel Vasculitis Presentation. Case Rep Rheumatol 2020; 2020:9146842. [PMID: 32099712 PMCID: PMC7037530 DOI: 10.1155/2020/9146842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/24/2022] Open
Abstract
Multiple myeloma can have different clinical manifestations, and not all patients present with classic CRAB component. We describe a 46-year-old woman admitted to our hospital with a complaint of a bluish-to-black discoloration of the second toe that was rapidly progressive and acute kidney injury. We documented a Kappa light chain monoclonal gammopathy, increased presence of plasmacytes in bone marrow aspiration, and multiple lytic bone lesions, which led to a diagnosis of multiple myeloma. Although multiple myeloma presenting with blue finger syndrome is uncommon, it must always be considered as a differential diagnosis with this clinical finding.
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14
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Tartari F, Di Altobrando A, Merli Y, Patrizi A, Mirelli M, Bianchi T. Blue Toe Syndrome: A Challenging Diagnosis. Indian J Dermatol 2020; 64:506-507. [PMID: 31896856 PMCID: PMC6862376 DOI: 10.4103/ijd.ijd_580_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Federico Tartari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
| | - Ambra Di Altobrando
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
| | - Yuri Merli
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
| | - Michele Mirelli
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
| | - Tommaso Bianchi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine and Vascular Surgery Unit, University of Bologna, Bologna, Italy
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15
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Abstract
Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.
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Affiliation(s)
- Alejandro Godoy
- Thrombosis and Vascular Medicine Service, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Aldo Hugo Tabares
- Thrombosis and Vascular Medicine Service, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto de Ciencias Biomédicas de Córdoba (IUCBC), Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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16
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Dimond DG, Lam JK, Wurster L, Kiser C, Driscoll K, Razzante M. The Solitary Blue Toe: A Unique Presentation of Antiphospholipid Syndrome. J Am Podiatr Med Assoc 2019; 109:235-240. [PMID: 31268794 DOI: 10.7547/17-108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented.
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17
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The usefulness of Duplex Doppler ultrasound in the angiological and dermatological diagnosis of patients with blue toe syndrome. Postepy Dermatol Alergol 2018; 34:478-484. [PMID: 29507564 PMCID: PMC5831285 DOI: 10.5114/ada.2017.71117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Peripheral microembolism is one of the most frequent causes of acute limb ischemia. In order to effectively prevent relapses it is essential to localize and eliminate the source of embolism. Aim To evaluate the role of Duplex Doppler ultrasound examination in identifying the causes of blue toe syndrome (BTS). Material and methods The group of 165 patients with clinical symptoms of BTS on their upper limbs (n = 16) and lower limbs (n = 149) was investigated. They all underwent Duplex Doppler ultrasound of the major arteries of the extremities, where ischemic changes occurred. Results Morphological and functional changes which might be potential sources of microembolism were identified in 146 patients. These changes included significant short-length stenoses or unstable atherosclerotic plaque (n = 73), true aneurysms (n = 42) and pseudoaneurysms (n = 17). In 11 cases, pathology of vascular prostheses in the form of anastomotic aneurysms, infection and residual thrombi after fibrinolysis was detected. In all cases, Duplex diagnosis was confirmed by other imaging and intraoperative tests. Conclusions Duplex Doppler ultrasound of the arteries in the affected limb with a full length view should be the first-line examination in diagnosing patients with BTS. In the absence of hemodynamic blood flow disturbances in the major arteries in patients with symptoms of BTS, it is advisable to start haematological tests to identify/exclude congenital or acquired thrombophilia.
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18
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Neuman R, Wabbijn M, Guillen S, Dees A. Blue toe syndrome as a first sign of systemic sclerosis. BMJ Case Rep 2018; 2018:bcr-2017-221613. [PMID: 29305361 DOI: 10.1136/bcr-2017-221613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.
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Affiliation(s)
- Rugina Neuman
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Marike Wabbijn
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Samara Guillen
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Adriaan Dees
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
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19
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Schattner A. Out of the blue finger ischaemia and occult colorectal cancer. BMJ Case Rep 2017; 2017:bcr2016218779. [PMID: 29161683 PMCID: PMC5353461 DOI: 10.1136/bcr-2016-218779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/03/2022] Open
Abstract
A woman aged 66 years with a history of unprovoked deep venous thrombosis (DVT) presented with persistent digital ischaemic changes of 2 of her right hand fingers. Physical examination was otherwise normal and extensive laboratory and imaging studies were unremarkable. A history of unprovoked DVT and the current episode of digital ischaemia prompted concern for underlying occult malignancy. Repeated history-taking revealed a strongly positive family history suggesting an occult colorectal cancer. Colonoscopy with biopsy revealed adenocarcinoma. Adenocarcinoma of the colon has rarely been associated with paraneoplastic acral vascular syndrome. This report suggests that occult malignancy needs to be considered in patients with focal digital ischaemia as this association is poorly unrecognised.
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Affiliation(s)
- Ami Schattner
- Hebrew University Faculty of Medicine, Jerusalem, Israel
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21
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A Controlled Study of Alprostadil Liposomal Preparation in the Treatment of Blue Toe Syndrome. Cell Biochem Biophys 2016; 72:265-8. [PMID: 25534490 DOI: 10.1007/s12013-014-0448-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study is to examine the efficacy of alprostadil liposomal preparation in the treatment of blue toe syndrome. As many as 32 patients with blue toe syndrome were randomized into the test group and a control group. Patients out of the test group were treated with alprostadil liposomal preparation, while those out of the control group received placebo administration. Inter-group comparisons were conducted for the post-therapeutic changes of microcirculation and improvements of clinical symptoms. In the test group, there were eight subjects with marked response (50.0 %), six subjects with partial response (37.5 %), and two subjects with no response (12.5 %), with the overall response rate of 87.5 %. In the control group, there were three cases (18.8 %), one case (6.4 %), and 12 cases (75 %), respectively, with the overall response rate of 25.0 %. The inter-group difference of response was statistically significant (Χ (2) = 12.987, P = 0.002 < 0.05). In the test group, there was one case of administration site redness which could be resolved spontaneously. No other adverse drug reactions were reported. No any complaints were reported for the control group. The inter-group difference of nail-fold microcirculation was not statistically significant (P > 0.05). The post-therapeutic points of nail-fold microcirculation in the test group decreased significantly (P < 0.05), but no significant changes were observed for the control group (P > 0.05). The post-therapeutic waveform changes of photoelectric plethysmography were significant for the test group in comparison to the control. The safety and efficacy of alprostadil liposomal preparation have been demonstrated in the treatment of blue toe syndrome.
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Lambova SN. The Place of Nailfold Capillaroscopy Among Instrumental Methods for Assessment of Some Peripheral Ischaemic Syndromes in Rheumatology. Folia Med (Plovdiv) 2016; 58:77-88. [PMID: 27552783 DOI: 10.1515/folmed-2016-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/04/2016] [Indexed: 11/15/2022] Open
Abstract
Micro- and macrovascular pathology is a frequent finding in a number of common rheumatic diseases. Secondary Raynaud's phenomenon (RP) is among the most common symptoms in systemic sclerosis and several other systemic autoimmune diseases including a broad differential diagnosis. It should be also differential from other peripheral vascular syndromes such as embolism, thrombosis, etc., some of which lead to clinical manifestation of the blue toe syndrome. The current review discusses the instrumental methods for vascular assessments. Nailfold capillaroscopy is the only method among the imaging techniques that can be used for morphological assessment of the nutritive capillaries in the nailfold area. Laser-Doppler flowmetry and laser-Doppler imaging are methods for functional assessment of microcirculation, while thermography and plethysmography reflect both blood flow in peripheral arteries and microcirculation. Doppler ultrasound and angiography visualize peripheral arteries. The choice of the appropriate instrumental method is guided by the clinical presentation. The main role of capillaroscopy is to provide differential diagnosis between primary and secondary RP. In rheumatology, capillaroscopic changes in systemic sclerosis have been recently defined as diagnostic. The appearance of abnormal capillaroscopic pattern inherits high positive predictive value for the development of a connective tissue disease that is higher than the predictive value of antinuclear antibodies. In cases of abrupt onset of peripheral ischaemia, clinical signs of critical ischaemia, unilateral or lower limb involvement, Doppler ultrasound and angiography are indicated. The most common causes for such clinical picture that may be referred to rheumatologic consultation are the antiphospholipid syndrome, mimickers of vasculitides such as atherosclerosis with cholesterol emboli, and neoplasms.
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Affiliation(s)
- Sevdalina N Lambova
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Choi KH, Yoo J, Huh JW, Jeong YI, Kim MS, Jue MS, Park HJ. Blue Toe Syndrome as an Early Sign of Disseminated Intravascular Coagulation. Ann Dermatol 2016; 28:400-1. [PMID: 27274647 PMCID: PMC4884725 DOI: 10.5021/ad.2016.28.3.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Jisook Yoo
- Department of Dermatology, VHS Medical Center, Seoul, Korea
| | - Joon Won Huh
- Department of Dermatology, VHS Medical Center, Seoul, Korea
| | - Young-In Jeong
- Department of Dermatology, VHS Medical Center, Seoul, Korea
| | - Min Soo Kim
- Department of Dermatology, VHS Medical Center, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, VHS Medical Center, Seoul, Korea
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Belsky J, Alvey H, Bencze A, Thompson B, Stokes-Buzzelli S. Blue toe syndrome, ischemic pain treated with digital block. Intern Emerg Med 2015; 10:637-8. [PMID: 25605677 DOI: 10.1007/s11739-015-1190-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Justin Belsky
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,
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Gonzalez Monroy JE, Orbach DB, VanderVeen D. Complications of Intra-Arterial Chemotherapy for Retinoblastoma. Semin Ophthalmol 2014; 29:429-33. [DOI: 10.3109/08820538.2014.959188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tschetter AJ, Liu V, Wanat KA. Cutaneous polyarteritis nodosa presenting as a solitary blue toe. J Am Acad Dermatol 2014; 71:e95-7. [PMID: 25128146 DOI: 10.1016/j.jaad.2014.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/18/2014] [Accepted: 03/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Amanda Joy Tschetter
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Vincent Liu
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Abstract
The foot is the target organ of a variety of internal diseases. Of upmost importance is the diabetic foot syndrome (DFS). Its complex pathophysiology is driven by the diabetic neuropathy, a vastly worsening effect is contributed by infection and ischemia. Seemingly localised lesions have the potential for phlegmone and septicaemia if not diagnosed and drained early. The acral lesions of peripheral artery occlusive disease (PAOD) have unique features as well. However, their life-threatening potential is lower than that of DFS even if the limb is critical. Notably, isolated foot lesions with a mere venous cause may arise from insufficient perforator veins; the accompanying areas of haemosiderosis will lead the diagnostic path. Cholesterol embolization (blue toe syndrome, trash foot) elicits a unique clinical picture and will become more frequent with increasing numbers of catheter-based procedures. Finally, descriptions are given of podagra and of foot mycosis as disease entities not linked to perfusion. The present review focuses on the depiction of disease and its diagnosis, leaving therapeutic considerations untouched.
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Affiliation(s)
- C Stelzner
- Medizinische Klinik 2, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Friedrichstr. 41, 01067, Dresden, Deutschland,
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Blue toe syndrome as the initial manifestation of ANCA-associated vasculitis. Open Med (Wars) 2013. [DOI: 10.2478/s11536-012-0142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe blue (or purple) toe syndrome describes the development of a blue or violaceous discoloration in one or more toes in the absence of obvious trauma, serious cold-induced injury or disorders producing generalized cyanosis. The presence of blue toe syndrome requires the clinician to search for primary systemic vasculitides, as well as for malignancy, underlying infection, thrombosis, cardiovascular pathology and other diseases. An accurate diagnosis is critical because many of the causes threaten life or limb, but the patient’s medical history, accompanying non-dermatologic findings on physical examination and the use of discriminatory laboratory tests are usually more important than the nature of the cutaneous abnormalities. We describe the case of a 53-year-old Caucasian male patient presenting with blue toe syndrome as the initial manifestation of ANCA-associated vasculitis.
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Goforth WD, Kruse D, Brantigan CO, Stone PA. Acute ischemia after revision hallux valgus surgery leading to amputation. J Foot Ankle Surg 2013; 52:757-61. [PMID: 23993040 DOI: 10.1053/j.jfas.2013.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Indexed: 02/03/2023]
Abstract
Acute arterial insufficiency after revision hallux valgus surgery is a rare complication. The identification of surgical candidates who are at risk of vascular complications is of utmost importance. The patient-reported symptoms and physical findings combined with noninvasive vascular studies are generally reliable to assess the vascular status but can fail to identify patients with atypical disease patterns. We present the case of a patient with normal pulses who underwent revision hallux valgus surgery, leading to gangrene of the hallux that required transmetatarsal amputation. We reviewed the vascular evaluation methods and causes of acute ischemia after surgery, including vasculitis.
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Affiliation(s)
- W David Goforth
- Second Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO
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Martini M, Perez-Marcos D, Sanchez-Vives MV. What Color is My Arm? Changes in Skin Color of an Embodied Virtual Arm Modulates Pain Threshold. Front Hum Neurosci 2013; 7:438. [PMID: 23914172 PMCID: PMC3728482 DOI: 10.3389/fnhum.2013.00438] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022] Open
Abstract
It has been demonstrated that visual inputs can modulate pain. However, the influence of skin color on pain perception is unknown. Red skin is associated to inflamed, hot and more sensitive skin, while blue is associated to cyanotic, cold skin. We aimed to test whether the color of the skin would alter the heat pain threshold. To this end, we used an immersive virtual environment where we induced embodiment of a virtual arm that was co-located with the real one and seen from a first-person perspective. Virtual reality allowed us to dynamically modify the color of the skin of the virtual arm. In order to test pain threshold, increasing ramps of heat stimulation applied on the participants’ arm were delivered concomitantly with the gradual intensification of different colors on the embodied avatar’s arm. We found that a reddened arm significantly decreased the pain threshold compared with normal and bluish skin. This effect was specific when red was seen on the arm, while seeing red in a spot outside the arm did not decrease pain threshold. These results demonstrate an influence of skin color on pain perception. This top-down modulation of pain through visual input suggests a potential use of embodied virtual bodies for pain therapy.
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Affiliation(s)
- Matteo Martini
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , Barcelona , Spain ; EVENT-Lab, Facultat de Psicologia, Universitat de Barcelona , Barcelona , Spain
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Passarini B, Pileri A, Neri I, Piraccini BM, Reggiani C, Patrizi A. Chilblain lupus erythematosus in a patient affected by Hodgkin lymphoma. Australas J Dermatol 2013; 54:74-5. [DOI: 10.1111/ajd.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Beatrice Passarini
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
| | - Alessandro Pileri
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
| | - Iria Neri
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
| | - Camilla Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
| | - Annalisa Patrizi
- Department of Experimental, Diagnostic and Specialty Medicine; Division of Dermatology; Bologna University; Bologna; Italy
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Griffin KJ, Rankine J, Kessel D, Berridge DC, Scott DJA. Compression of the dorsalis pedis artery: a novel cause of blue toe syndrome. Vascular 2012; 20:325-8. [DOI: 10.1258/vasc.2011.cr0323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blue toe syndrome (BTS) is an important vascular condition characterized by painful blue discoloration of one or more digits. It is frequently due to emboli and is important because of the risk of progressive ischemia and tissue loss. A 53-year-old male presented with recurrent episodes of painful blue discoloration and blistering of the skin of the right hallux. On examination, the patient was found to have a cool, blue-purple great toe; all peripheral pulses were present. The patient was investigated for coagulopathy and potential sources of emboli, but the only abnormality was significant stenosis of the dorsalis pedis artery due to extrinsic compression by the extensor hallucis brevis tendon. In the absence of any other embolic source or abnormality, we believe that this case presents a novel and potentially remediable cause of BTS and indicates the need for a careful search for an underlying lesion when common causes of BTS have been excluded.
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Affiliation(s)
- K J Griffin
- Leeds Vascular Institute, Leeds General Infirmary
| | - J Rankine
- Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - D Kessel
- Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - D C Berridge
- Leeds Vascular Institute, Leeds General Infirmary
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary
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Spontaneous cutaneous cholesterol crystal embolism with focal clinical symptomatology: report of a case in an unusual location with secondary histological changes reminiscent of atypical decubital fibroplasia. Am J Dermatopathol 2012; 33:726-8. [PMID: 21946763 DOI: 10.1097/dad.0b013e31820b2988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cholesterol crystal embolization (CCE) is one of the many complications of atherosclerosis. CCE is usually an iatrogenic event occurring either after vascular surgery, usually aortic surgery, or invasive angiographic investigations or in the course of anticoagulant or thrombolytic therapy. More rarely, it occurs after trauma or even in the absence of any inciting cause. CCE may manifest with single or multiorgan involvement. Skin involvement is usually seen in the context of a systemic disease, especially affecting the lower extremities and lower trunk. We report on a rare case of isolated spontaneous focal cutaneous involvement of the upper limb, with peculiar mesenchymal and reactive histological changes. A 65-year-old man with a clinical history of atherosclerosis was admitted complaining of a nonhealing painful skin ulceration on his left elbow for 5-month duration. A skin biopsy was taken, and histopathological examination documented an intrarteriolar cholesterol embolus in the dermis along with a peculiar adjacent bizarre fibroblastic reaction, of the type usually seen in atypical decubital fibroplasia of debilitated patients. The ulceration was surgically excised, and the wound was sutured and repaired. At 18-month follow-up, the patient has no evidence of local disease.
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Blue Toe Sign as the Initial Manifestation of a Popliteal Artery Aneurysm. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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36
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Signo del dedo azul como manifestación inicial de aneurisma de la arteria poplítea. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:551-2. [DOI: 10.1016/j.ad.2010.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/01/2010] [Accepted: 09/08/2010] [Indexed: 11/17/2022] Open
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Al Aboud A, Abrams M, Mancini AJ. Blue toes after stimulant therapy for pediatric attention deficit hyperactivity disorder. J Am Acad Dermatol 2011; 64:1218-9. [PMID: 21571204 DOI: 10.1016/j.jaad.2009.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/01/2009] [Accepted: 11/06/2009] [Indexed: 11/17/2022]
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38
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George M, Pakran J, Rajan U, Thomas S, George S. Toe-tip purpura. Int J Dermatol 2011; 50:923-4. [PMID: 21781061 DOI: 10.1111/j.1365-4632.2010.04842.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mamatha George
- Department of Dermatology, Calicut Medical College, Calicut, Kerala, India.
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Abstract
Acrocyanosis is symmetric, painless, discoloration of different shades of blue in the distal parts of the body that is marked by symmetry, relative persistence of the skin color changes with aggravation by cold exposure, and frequent association with local hyperhidrosis of hands and feet. Described over a century ago and despite seeming familiarity, it remains a poorly understood condition that shares much in clinical presentation with other conditions characterized by skin color changes in the distal parts of the body. The diagnosis remains mostly clinical, and pathological mechanisms vary suggesting that acrocyanosis may not be a single entity. We performed an extensive literature review to summarize existing knowledge about the demographics, pathology, diagnosis, and treatment of this condition.
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Oya J, Hanai K, Miura J, Maruyama S, Ishii A, Syono K, Shinjo T, Iwamoto Y. Diabetic gangrene in multiple fingers and toes after a dog bite in an elderly patient with type 2 diabetes. Intern Med 2011; 50:1303-7. [PMID: 21673466 DOI: 10.2169/internalmedicine.50.4930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old diabetic woman experienced multiple sites of gangrene not only in fingers that were directly bitten by a dog but also in fingers and toes that had not beenbitten. Her glycemic control was fair and microvascular complications were mild. There were no clinical findings related to angitis, collagenosis or severe infection. The fingers and toes with gangrene were amputated. The pathological diagnosis was diabetic gangrene. This report presents a case of multiple sites of gangrene of the fingers and toes after a dog bite in an elderly patient with type 2 diabetes.
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Affiliation(s)
- Junko Oya
- Diabetes Center, Tokyo Women's Medical University, Japan.
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Postema PG, Regeer MV, van der Valk PR, Stroes ESG, Richel DJ. Blue toe syndrome and sunitinib. Int J Clin Oncol 2010; 16:574-6. [DOI: 10.1007/s10147-010-0153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/15/2010] [Indexed: 11/27/2022]
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Bégon E, Bouilly P, Cheysson E, Cohen P, Bachmeyer C. Isolated blue toe syndrome as the initial sign of Wegener granulomatosis. Am J Med 2010; 123:e7-8. [PMID: 20609674 DOI: 10.1016/j.amjmed.2009.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 11/23/2009] [Accepted: 11/25/2009] [Indexed: 11/17/2022]
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Kluger N, Fabre S, Durand L, Guillot B. Spontaneous cutaneous cholesterol embolism. Presse Med 2010; 39:738-9. [DOI: 10.1016/j.lpm.2009.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 07/09/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022] Open
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Prendiville JS, Crow YJ. Blue (or purple) toes: Chilblains or chilblain lupus-like lesions are a manifestation of Aicardi–Goutières syndrome and familial chilblain lupus. J Am Acad Dermatol 2009; 61:727-8. [DOI: 10.1016/j.jaad.2009.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 04/07/2009] [Accepted: 05/03/2009] [Indexed: 10/20/2022]
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