A case of Burkitt's lymphoma presenting with digital ischaemia

Cold-Induced Skin Disorders

Background:

Humans are commonly exposed to extremes in temperature. Fortunately, our skin behaves as an anatomic and physiologic barrier during these periods. Exposure to cold temperatures may result in a variety of symptoms and disorders.

Objective:

Our current understanding of the pathophysiology, clinical presentation, and therapies of cold-induced skin disorders are reviewed.

Methods:

Studies, reviews, and book chapters that contained information on cold-induced skin disorders were reviewed.

Conclusion:

Cold-induced skin disorders are a heterogeneous group of disorders that cause great morbidity, particularly in cold climates. These entities can be classified as physiologic or pathologic responses to freezing or nonfreezing cold exposure.

Acrocyanosis: the Flying Dutchman

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.

Acute upper arm ischaemia: a rare presentation of non-Hodgkin's lymphoma

Digital ischaemia has been sparsely reported in current literature. Its association with lymphomatous conditions has been described in even more exceptional occurrences. We present the first case of upper arm ischaemia associated with non-Hodgkin's lymphoma. A brief literature review of this rare phenomenon is also accompanied with it.

[Digital arteritis preceding the diagnosis of a malignant B cell lymphoma]

We report the case of a young smoker woman who developed a severe acrosyndrome of rapid onset, involving both hands except the thumbs. The angiography showed digital arteritis. Antinuclear antibodies were present at high level. Three months later, a large B cell lymphoma was diagnosed. Complete remission was achieved, but the acrosyndrome persisted with only partial improvement. The antinuclear antibodies disappeared. The paraneoplastic nature of the acrosyndrome is discussed.

Burkitt lymphoma presenting as colonic ischemia and overwhelming sepsis

Lymphomas may occasionally present as acute surgical emergencies in children, most commonly because of obstruction, intussusception, or direct bowel invasion. We present the case of a 14-year-old adolescent boy who presented with septic shock and was found to have necrosis of the cecum because of a Burkitt lymphoma. The cause of the ischemia appeared to be mesenteric infiltration and subsequent vascular compromise of the bowel. We discuss the management of this patient and present a review of the literature.