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Zakaria ER, Wan Ghazali WS, Sazali H, Shahril NS, Md Salleh S, Mohd Nawi SN. Acrocyanosis as a rare presentation of drug-induced cutaneous vasculitis: a case report. BMC Rheumatol 2024; 8:41. [PMID: 39256797 DOI: 10.1186/s41927-024-00413-7] [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: 07/01/2024] [Accepted: 09/02/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Acrocyanosis is characterised by persistent bluish discolouration of the extremities, resulting from reduced peripheral blood flow leading to increased oxygen extraction. The aetiology can be divided into primary and secondary causes. While primary acrocyanosis is generally painless and has a benign course, secondary causes may lead to complications. This case reported acrocyanosis secondary to cutaneous vasculitis which progressed to digital gangrene, which is a rare complication of cutaneous vasculitis. CASE PRESENTATION A 68-year-old man presented with a four-day history of bluish discolouration involving bilateral toes associated with pain and started to become gangrenous. Investigations for critical limb ischemia did not show evidence of critical arterial stenosis. Further history revealed history of recent administration of intramuscular injections with diclofenac, a non-steroidal anti-inflammatory agent for renal colic pain a few days prior to the onset of the. Thorough skin search showed multiple purpuric rash of his thighs, buttocks and abdomen. Skin biopsy confirmed the diagnosis of cutaneous (lymphocytic) vasculitis, which was likely to be drug-induced. The acrocyanosis initially responded to methylprednisolone, however unfortunately it progressed further to digital gangrene which required bilateral transmetatarsal amputations. CONCLUSION Knowledge on clinical features, aetiology and investigations of secondary acrocyanosis is crucial for early recognition and treatment of the underlying cause to prevent irreversible complications.
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Affiliation(s)
- Ezwan Rafizi Zakaria
- School of Medical Sciences, Universiti Sains Malaysia, Health Campus Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Wan Syamimee Wan Ghazali
- School of Medical Sciences, Universiti Sains Malaysia, Health Campus Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Hafsah Sazali
- School of Medical Sciences, Universiti Sains Malaysia, Health Campus Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Nor Shuhaila Shahril
- Department of Medicine, Hospital Putrajaya, Wilayah Persekutuan Putrajaya, Putrajaya, Malaysia
| | - Salzihan Md Salleh
- School of Medical Sciences, Universiti Sains Malaysia, Health Campus Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia
- Department of Pathology, Universiti Sains Malaysia, Health Campus, Kubang kerian, Kota Bharu, Kelantan, Malaysia
| | - Siti Nurbaya Mohd Nawi
- School of Medical Sciences, Universiti Sains Malaysia, Health Campus Kubang Kerian, Kota Bharu, Kelantan, 16150, Malaysia.
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
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2
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Guelimi R, Monfort JB, Chaby G, Lok C, Lazareth I, Maillard H, Beneton N, Kottler D, Blaise S, Imbert B, Journet J, Goujon E, Jacquin A, Tella E, Vicaut E, Klejtman T, Senet P. Nailfold capillaroscopy in acrocyanosis among patients with associated Raynaud's phenomenon. Ann Dermatol Venereol 2024; 151:103309. [PMID: 39178618 DOI: 10.1016/j.annder.2024.103309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/03/2024] [Accepted: 07/11/2024] [Indexed: 08/26/2024]
Affiliation(s)
- R Guelimi
- Department of Dermatology, Vascular Medicine and Allergology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, F-75020 Paris, France.
| | - J-B Monfort
- Department of Dermatology, Vascular Medicine and Allergology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, F-75020 Paris, France
| | - G Chaby
- Dermatology of Department, Amiens-Picardie University Hospital Center, F-80000 Amiens, France
| | - C Lok
- Dermatology of Department, Amiens-Picardie University Hospital Center, F-80000 Amiens, France
| | - I Lazareth
- Department of Vascular Medicine, Institut de la cicatrisation Jean-Paul-Belmondo, Paris Saint-Joseph Hospital, F-75014 Paris, France
| | - H Maillard
- Department of Dermatology, Le Mans Hospital Centre, F-72037 Le Mans, France
| | - N Beneton
- Department of Dermatology, Le Mans Hospital Centre, F-72037 Le Mans, France
| | - D Kottler
- Department of Dermatology, Caen Hospital Centre, F-14033 Caen, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - B Imbert
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - J Journet
- Department of Dermatology, William Morey Hospital, F-71100 Chalon-sur-Saône, France
| | - E Goujon
- Department of Dermatology, William Morey Hospital, F-71100 Chalon-sur-Saône, France
| | - A Jacquin
- Department of Dermatology and Vascular Medicine, Victor-Dupouy Hospital, F-95100 Argenteuil, France
| | - E Tella
- Department of Dermatology and Vascular Medicine, Victor-Dupouy Hospital, F-95100 Argenteuil, France
| | - E Vicaut
- Clinical Research Unit, Fernand Vidal Hospital F-75010 Paris, France
| | - T Klejtman
- Department of Vascular Medicine, Institut de la cicatrisation Jean-Paul-Belmondo, Paris Saint-Joseph Hospital, F-75014 Paris, France
| | - P Senet
- Department of Dermatology, Vascular Medicine and Allergology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, F-75020 Paris, France
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3
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Raturi M, Dhiman Y, Gaur DS, Nautiyal R, Bhardwaj T. Icepack-Induced transient vasospasm leading to acrocyanosis in an Indian blood donor: A rare occurrence. Transfus Clin Biol 2024; 31:188-189. [PMID: 38866075 DOI: 10.1016/j.tracli.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Manish Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India.
| | - Yashaswi Dhiman
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India
| | - Dushyant Singh Gaur
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India
| | - Rolika Nautiyal
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India
| | - Tushar Bhardwaj
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India
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4
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Ture HY, Lee NY, Kim NR, Nam EJ. Raynaud's Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment. Vasc Specialist Int 2024; 40:26. [PMID: 39040029 PMCID: PMC11266082 DOI: 10.5758/vsi.240047] [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: 05/07/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024] Open
Abstract
Raynaud's phenomenon (RP) is a condition characterized by episodic, excessive vasoconstriction in the fingers and toes, triggered by cold or stress. This leads to a distinctive sequence of color changes in the digits. Pallor indicates reduced blood flow due to oxygen deprivation, while erythema appears as reperfusion. RP can be primary, with no identifiable underlying cause, or secondary, associated with other conditions. These conditions include autoimmune diseases, most commonly systemic sclerosis, vascular diseases; and neurological conditions. While the exact cause of RP remains unclear, genetic and hormonal (estrogen) factors are likely contributors. The pathogenesis of RP involves a complex interaction between the vascular wall, nerves, hormones, and humoral factors, disrupting the balance between vasoconstriction and vasodilation. In primary RP, the vascular abnormalities are primarily functional. However, in secondary RP, both functional and structural components occur in blood vessels. This explains why digital tissue damage frequently occurs in secondary RP but not primary RP. Diagnosis of RP is primarily clinical. Recent advancements in imaging techniques have aided in diagnosis and monitoring, but nail fold capillaroscopy remains the gold standard for distinguishing between primary and secondary RP. If there are signs of acute ischemic injury, vascular imaging, particularly preoperatively, is crucial to rule out other vaso-occlusive conditions. Management of RP focuses on alleviating symptoms and preventing tissue damage. Vasodilator medications are the first-line treatment when general measures like warmth and stress management are not sufficient. Dihydropyridine calcium channel blockers (CCBs), such as nifedipine, are commonly used for vasodilation. Phosphodiesterase-5 inhibitors and prostaglandin analogs are alternative options for patients who do not respond to CCBs or have ischemic tissue damage. Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers. For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control RP symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy's long-term effectiveness is uncertain. Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.
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Affiliation(s)
- Hirut Yadeta Ture
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Nan Young Lee
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Na Ri Kim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eon Jeong Nam
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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5
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Solomon AL, Ratchford EV. Vascular Disease Patient Information Page: Achenbach syndrome (paroxysmal finger hematoma). Vasc Med 2024; 29:229-232. [PMID: 38334054 DOI: 10.1177/1358863x231223524] [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: 02/10/2024]
Affiliation(s)
| | - Elizabeth V Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Smith LL. Similarities and differences regarding acute anorexia nervosa and semi-starvation: does behavioral thermoregulation play a central role? Front Behav Neurosci 2023; 17:1243572. [PMID: 37953827 PMCID: PMC10634530 DOI: 10.3389/fnbeh.2023.1243572] [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: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To clarify the association between acute anorexia nervosa (AN) and semi-starvation (SS) by focusing on similarities and differences in physiology, mood, and behavior. Method A comparison of published literature between these two groups. Results Both groups show similar hormonal and metabolic changes in response to caloric restriction and extreme weight loss (~25%). Associated changes result in a reduced body temperature (Tcore-low). Maintenance of body temperature within a specific range is crucial to survival. However, both groups cannot activate autonomic strategies to maintain their Tcore-low, such as increasing metabolic rate, constricting skin blood vessels, or shivering. Furthermore, Tcore-low increases the individuals' "coldness sensations" throughout the body, hence the frequent reports from ANs and SSs of "feeling cold." To eliminate these uncomfortable "coldness sensations" and, importantly, to maintain Tcore-low, ANs, and SSs "select" different thermoregulatory behavioral strategies. It is proposed that the primary differences between AN and SS, based on genetics, now manifest due to the "selection" of different thermo-regulatory behaviors. AN patients (ANs) "select" hyperactive behavior (HyAc), which increases internal metabolic heat and thus assists with maintaining Tcore-low; in harmony with hyperactive behavior is a lively mood. Also related to this elevated arousal pattern, ANs experience disrupted sleep. In contrast, SS individuals "select" a passive thermo-behavioral strategy, "shallow torpor," which includes reduced activity, resulting in energy conservation. In addition, this inactivity aids in the retention of generated metabolic heat. Corresponding to this lethargic behavior, SS individuals display a listless mood and increased sleep. Conclusion Initial similarities between the two are attributable to physiological changes related to extreme weight loss. Differences are most likely attributable to genetically programmed "selection" of alternate thermoregulatory strategies, primarily to maintain Tcore-low. However, if acute AN is prolonged and evolves into a chronic condition, AN will more closely align with starvation and more precisely reflect SS symptomology.
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Affiliation(s)
- Lucille Lakier Smith
- Human Performance Laboratory, Department of Kinesiology, School of Health Sciences, East Carolina University, Greenville, NC, United States
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7
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Kadian-Dodov D. Cold Hands or Feet: Is It Raynaud's or Not? Med Clin North Am 2023; 107:829-844. [PMID: 37541711 DOI: 10.1016/j.mcna.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Raynaud's phenomenon is an exaggerated response to cold stimuli that may be primary or secondary. The diagnosis relies on patient history and physical examination to distinguish RP from other vasomotor dysfunction (e.g. acrocyanosis, pernio, small fiber neuropathy with vasomotor symptoms, and complex regional pain syndrome). Achenbach syndrome, or spontaneous venous hemorrhage, may also be mistaken for RP but is a self-limiting phenomenon. Laboratory evaluation and vascular diagnostic testing may identify SRP causes. Regardless of etiology, treatment includes warming with trigger avoidance, and consideration of vasodilators (eg. calcium channel, alpha-1 blockers). SRP with digital ulceration may require PDE5i, endothelin-1 receptor blockers, and prostanoids. Refractory cases may require pneumatic arterial pumps, botulinum toxin administration, or surgical sympathectomy.
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Affiliation(s)
- Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1030, New York, NY 10029, USA.
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8
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Raja A, Karch J, Shih AF, De La Garza H, De Zepeda Diaz AJ, Maymone MBC, Phillips TJ, Secemsky E, Vashi N. Part II: Cutaneous manifestations of peripheral vascular disease. J Am Acad Dermatol 2023; 89:211-226. [PMID: 35504485 DOI: 10.1016/j.jaad.2021.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 10/18/2022]
Abstract
In this Part 2 of a 2-part continuing medical education series, we review the epidemiology of peripheral vascular disease, its association with cutaneous symptoms, and the diagnosis and evaluation of cutaneous features of vascular disorders. As peripheral vascular disease becomes more prevalent globally, it is essential for dermatologists to become competent at accurately recognizing and diagnosing cutaneous manifestations and directing individuals to receive appropriate care and treatment.
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Affiliation(s)
- Aishwarya Raja
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jamie Karch
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Allen F Shih
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Henriette De La Garza
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mayra B C Maymone
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Smith Center for Outcomes Research, Departments of Cardiology and Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, US Department of Veteran Affairs, Boston Health Care System, Boston, Massachusetts.
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9
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Azeez Z, Vallabhaneni P. It is all blue! Arch Dis Child Educ Pract Ed 2023; 108:150-151. [PMID: 35772941 DOI: 10.1136/archdischild-2021-323520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Zak Azeez
- Child Health, Swansea Bay University Health Board, Port Talbot, UK
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10
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Haba Y, Naito T. Acrocyanosis Secondary to Esophageal Cancer. J Gen Intern Med 2023; 38:530-531. [PMID: 36333549 PMCID: PMC9905448 DOI: 10.1007/s11606-022-07854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Yuichiro Haba
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Toshio Naito
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
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11
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Ruiz-Rodríguez JF, Fernández-de Thomas RJ, De Jesus O. Secondary Acrocyanosis in a Paraplegic Patient With Spinal Cord Injury. Cureus 2022; 14:e29420. [PMID: 36299960 PMCID: PMC9586715 DOI: 10.7759/cureus.29420] [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] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Secondary acrocyanosis after spinal cord injury is extremely rare. We describe a case with secondary acrocyanosis in a complete T12 paraplegic patient. A 41-year-old man with complete T12 paraplegia after a gunshot wound to the thoracic spine 20 years prior presented with a four-month history of bilateral foot bluish discoloration precipitated when he sat with his legs down, improving rapidly after a few minutes of leg elevation. Changes in the skin color of the lower extremities were evaluated in the seated position for two hours. The skin color became darker, progressing to a bluish discoloration through the entire length of the legs. After two hours, the feet and most of the legs appeared deep purple. The color of the legs returned to their baseline three minutes later after the patient was placed supine in the bed. The diagnosis of secondary acrocyanosis due to the T12 spinal cord injury was established based on the physical examination and ancillary tests showing no peripheral ischemia. Other causes of secondary acrocyanosis were excluded during the work-up. This report presents the first case of a paraplegic patient with spinal cord injury presenting secondary acrocyanosis.
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12
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Manger B, Manger K. Pseudoacrocyanosis: a case for telemedicine in rheumatology. RMD Open 2022; 8:rmdopen-2022-002573. [PMID: 36096525 PMCID: PMC9472203 DOI: 10.1136/rmdopen-2022-002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 11/21/2022] Open
Abstract
Here we describe three patients, two of them medical doctors, who were concerned about striking, sudden-onset bluish discoloration of their hands. After sending electronic images of these changes to befriended rheumatologists, one simple anamnestic question could unveil the surprising cause of their symptoms.
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Affiliation(s)
- Bernhard Manger
- Medizinische Klinik 3, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Karin Manger
- Medical Practice for Rheumatology, Bamberg, Germany
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13
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Davies TC. The position of geochemical variables as causal co-factors of diseases of unknown aetiology. SN APPLIED SCIENCES 2022; 4:236. [PMID: 35909942 PMCID: PMC9326422 DOI: 10.1007/s42452-022-05113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract The term diseases of unknown aetiology (DUA) or idiopathic diseases is used to describe diseases that are of uncertain or unknown cause or origin. Among plausible geoenvironmental co-factors in causation of DUA, this article focusses on the entry of trace elements, including metals and metalloids into humans, and their involvement in humoral and cellular immune responses, representing potentially toxic agents with implications as co-factors for certain DUA. Several trace elements/metals/metalloids (micronutrients) play vital roles as co-factors for essential enzymes and antioxidant molecules, thus, conferring protection against disease. However, inborn errors of trace element/metal/metalloid metabolisms can occur to produce toxicity, such as when there are basic defects in the element transport mechanism. Ultimately, it is the amount of trace element, metal or metalloid that is taken up, its mode of accumulation in human tissues, and related geomedical attributes such as the chemical form and bioavailability that decisively determine whether the exerted effects are toxic or beneficial. Several case descriptions of DUA that are common worldwide are given to illustrate our knowledge so far of how trace element/metal/metalloid interactions in the immune system may engender its dysregulation and be implicated as causal co-factors of DUA. Article highlights The importance of a proper understanding of geochemical perturbations in human metabolisms is emphasisedIt is proferred that such an understanding would aid greatly in the decipherment of diseases of unknown aetiology (DUA)The thesis presented may pave the way towards better diagnosis and therapy of DUA.
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Affiliation(s)
- Theophilus C. Davies
- Present Address: Faculty of Natural Sciences, Mangosuthu University of Technology, 511 Mangosuthu Highway, 4031, KwaZulu Natal, South Africa
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14
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Klein-Weigel P, Ruttloff A, König D, Nielitz J, Steindl J, Sander O, Richter JG. [Functional vascular acrosyndromes]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:591-600. [PMID: 35925129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Vascular acrosyndromes are characterized by sparse, uniform clinical manifestations and a variety of possible pathomechanisms. The present article focuses on the functional entities. Raynaud phenomenon is based on cold- or stress-induced vasospasms of acral arteries. It is defined by the color changes of the skin, in the typical case white-blue-red (tricolore). The long fingers are most commonly affected. The etiology is unknown, and the pathophysiology is poorly understood. A distinction is made between primary and a secondary Raynaud phenomenon. The most important underlying diseases include collagenosis, primarily systemic sclerosis, and malignancies; furthermore, medications and drugs may promote vasospasm. Treatment is aimed at preventing or breaking the vasospasm, but has been only partially effective in doing so. Acrocyanosis is a vasospastic dystonic acral disorder that results in permanent reddish-livid discoloration, especially of the hands and feet. Secondary forms occur in collagenosis, malignancies, and myelodysplastic syndromes. The etiology and pathophysiology are virtually unknown. Targeted pharmacological intervention is not possible. Unlike all other vascular acrosyndromes, erythromelalgia is characterized by hyperemia. The primary form is a genetic sodium channelopathy, while secondary forms include malignancies, connective tissue diseases, and myelodysplastic syndromes. The symptoms are often distressing and disabling. Therapy requires a multimodal approach that includes both nonpharmacological and pharmacological strategies. Close interdisciplinary collaboration is essential for the management of this disease.
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Affiliation(s)
- Peter Klein-Weigel
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland.
| | - Andreas Ruttloff
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Dana König
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Jessica Nielitz
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Julia Steindl
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Oliver Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller-Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jutta G Richter
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller-Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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15
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Abstract
Vasospastic disorders are prevalent in the general population and can affect individuals of any age. Primary (or idiopathic) vasospastic disorders often have a benign course; treatment focuses on the control of symptoms. Secondary vasospastic disorders occur owing to an underlying condition and have an increased risk of complications, including tissue loss and digital ulcerations; treatment should focus on the underlying condition. In this review, we discuss the pathophysiology, clinical presentation, diagnosis, and management of vasospastic disorders, including Raynaud syndrome, acrocyanosis, livedo reticularis, and pernio.
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Affiliation(s)
- Ana I Casanegra
- Vascular Medicine Division, Cardiovascular Department, Gonda Vascular Center, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Roger F Shepherd
- Vascular Medicine Division, Cardiovascular Department, Gonda Vascular Center, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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16
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Smith LL. The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis. Front Behav Neurosci 2021; 15:700645. [PMID: 34421554 PMCID: PMC8377352 DOI: 10.3389/fnbeh.2021.700645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
Typically, the development of anorexia nervosa (AN) is attributed to psycho-social causes. Several researchers have recently challenged this view and suggested that hypothermia and hyperactivity (HyAc) are central to AN. The following hypothesis will attempt to clarify their role in AN. Anorexia nervosa patients (ANs) have significantly lower core temperatures (Tcore) compared to healthy controls (HCs). This reduced temperature represents a reset Tcore that needs to be maintained. However, ANs cannot maintain this Tcore due primarily to a reduced basal metabolic rate (BMR); BMR usually supplies heat to sustain Tcore. Therefore, to generate the requisite heat, ANs revert to the behavioral-thermoregulatory strategy of HyAc. The majority of ANs (~89%) are reportedly HyAc. Surprisingly, engagement in HyAc is not motivated by a conscious awareness of low Tcore, but rather by the innocuous sensation of "cold- hands" frequently reported by ANs. That is, local hand-thermoreceptors signal the brain to initiate HyAc, which boosts perfusion of the hands and alters the sensation of "cold-discomfort" to one of "comfort." This "rewarding" consequence encourages repetition/habit formation. Simultaneously, hyperactivity increases the availability of heat to assist with the preservation of Tcore. Additionally, HyAc induces the synthesis of specific brain neuromodulators that suppress food intake and further promote HyAc; this outcome helps preserve low weight and perpetuates this vicious cycle. Based on this hypothesis and supported by rodent research, external heat availability should reduce the compulsion to be HyAc to thermoregulate. A reduction in HyAc should decrease the production of brain neuromodulators that suppress appetite. If verified, hopefully, this hypothesis will assist with the development of novel treatments to aid in the resolution of this intractable condition.
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Affiliation(s)
- Lucille Lakier Smith
- Human Performance Laboratory, Department of Kinesiology, School of Health Sciences, East Carolina University, Greenville, NC, United States
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Sachdeva M, Mufti A, Maliyar K, Lara-Corrales I, Salcido R, Sibbald C. A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses. Adv Skin Wound Care 2021; 34:348-354. [PMID: 34125725 DOI: 10.1097/01.asw.0000752692.72055.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.
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18
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Takeuchi Y, Tsukagoshi J. Primary acrocyanosis. J Gen Fam Med 2021; 22:156-157. [PMID: 33977015 PMCID: PMC8090835 DOI: 10.1002/jgf2.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
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Abstract
Raynaud's phenomenon, which is characterized by episodic digital pallor, cyanosis and rubor upon exposure to cold environment or to stress, is relatively common, although the prevalence depends on the climate. Still, it is under-diagnosed, under-treated, and often confused with other conditions. Primary Raynaud's phenomenon (i.e., Raynaud disease) must be distinguished from secondary Raynaud's phenomenon (i.e., Raynaud syndrome) as long-term morbidity and outcomes differ vastly between the two conditions. Additionally, the practitioner must differentiate between Raynaud's phenomenon and related vascular disorders, such as acrocyanosis, pernio, and livedo reticularis. In this article, we review differences between the conditions and suggest an approach to diagnosis and treatment strategy for these disorders.
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Affiliation(s)
- Eunjung Choi
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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20
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Kent JT, Carr D. A visually striking case of primary acrocyanosis: A rare cause of the blue digit. Am J Emerg Med 2020; 40:227.e3-227.e4. [PMID: 32800682 PMCID: PMC7395312 DOI: 10.1016/j.ajem.2020.07.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Cold environments can trigger a variety of conditions, which, in their acute phase often present to the Emergency Department. Primary acrocyanosis is a distinct, rare condition which may be missed resulting in misdiagnosis and mismanagement. Primary acrocyanosis is a peripheral vascular disorder defined by painless, symmetrical discoloration of the distal appendages and uniquely characterized by persistence of the skin color changes after cold exposure. We present a case of a 24-year-old female who presented to the Emergency Department with peripheral cyanosis after cold exposure and was eventually diagnosed with primary acrocyanosis by Rheumatology. The prognosis for primary acrocyanosis is quite good in comparison to other acrosyndromes and once secondary causes of acrocyanosis have been ruled, out can be managed conservatively with lifestyle modifications and potential follow-up with Rheumatology.
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Affiliation(s)
- Jessica T Kent
- University of Toronto, Department of Emergency Medicine, 754 Avenue Rd, Toronto, ON M5P 1M2, Canada.
| | - David Carr
- Associate Professor of Emergency Medicine, Clinical Investigator, University Health Network, Medical Director of Stadium Medicine, Toronto Blue Jays, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
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Abstract
Diseases of the skin, hair, nails and mucosa can appear as flesh-colored lesions or may present as any of the colors of the visual spectrum. Diseases associated with blue (or shades of blue) discoloration represent a unique group of conditions that occur de novo or as a reaction to either a topical or a systemic agent to which the individual has been exposed. Blue diseases can affect the skin, the nails or the mucosal membranes of the mouth (buccal mucosa, gingiva, lips, palate or tongue) or eyes (sclera). In addition to appearing blue, they can also appear as blue-black, blue-brown, blue-gray, blue-green, blue-purple, blue-red, and blue-silver. The conditions range from those secondary to exogenous agents (systemic or tattoo or topical) to syndromes to systemic diseases to tumors (adnexal, melanocytic, vascular, or miscellaneous). A comprehensive attempt to include all conditions that have been described as blue (or a shade of blue) has been performed by evaluating the following terms using the medical search engine PubMed: blue and either gingiva, lips, lunula, mucosa, nails, oral, palate, sclera, skin, or tongue. Subsequently, the conditions were organized by color (blue and shades of blue) and within each color by location (skin, nails, oral mucosa and sclera). The results are presented in organized tables; in addition, there is discussion of some of the conditions that are unique to one or more specific locations. In conclusion, 'preserve and cherish the pale blue dot' and remember that a big red rock eater with chrysiasis is the answer to the riddle, "What is big and blue and eats rocks?"
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Affiliation(s)
- Philip R Cohen
- San Diego Family Dermatology, National City, California, USA; Adjunct Professor of Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, California, USA.
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Martini G, Cappella M, Culpo R, Vittadello F, Sprocati M, Zulian F. Infrared thermography in children: a reliable tool for differential diagnosis of peripheral microvascular dysfunction and Raynaud's phenomenon? Pediatr Rheumatol Online J 2019; 17:68. [PMID: 31619252 PMCID: PMC6794834 DOI: 10.1186/s12969-019-0371-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infrared Thermography (IRT) has been used for over 30 years in the assessment of Raynaud Phenomenon (RP) and other peripheral microvascular dysfunctions in adults but, to date, very little experience is available on its use in children for this purpose. The first aim of the study was to assess reproducibility of thermographic examination after cold exposure by comparing inter-observer agreement in thermal imaging interpretation. The secondary aim was to evaluate whether IRT is reliable to diagnose and differentiate peripheral circulation disturbances in children. METHODS Children with clinical diagnosis of primary Raynaud's phenomenon (PRP), secondary RP (SRP), acrocyanosis (AC) and age-matched controls underwent sequential measurements of skin temperature at distal interphalangeal (DIP) and metacarpophalangeal (MCP) joints with IRT at baseline and for 10 min after cold challenge test. Intraclass correlation coefficient (ICC) was calculated for inter-rater reliability in IRT interpretation, then temperature variations at MCP and DIP joints and the distal-dorsal difference (DDD) were analysed. RESULTS Fourteen PRP, 16 SRP, 14 AC and 15 controls entered the study. ICC showed excellent agreement (> 0.93) for DIPs and MCPs in 192 measures for each subject. Patients with PRP, SRP and acrocyanosis showed significantly slower recovery at MCPs (p < 0.05) and at DIPs (p < 0.001) than controls. At baseline, higher temperature at DIPs and lower at MCPs was observed in PRP compared with SRP with significantly lower DDD (p < 0.001). Differently from AC, both PRP and SRP showed gain of temperature at DIPs and less at MCPs after cold challenge. PRP but not SRP patients returned to DIPs basal temperature by the end of re-warming time. Analysis of DDD confirmed that controls and PRP, SRP and AC patients significantly differed in fingers recovery pattern (p < 0.05). CONCLUSION IRT appears reliable and reproducible in identifying children with peripheral microvascular disturbances. Our results show that IRT examination pointed out that PRP, SRP and AC patients present significant differences in basal extremities temperature and in re-warming pattern after cold challenge therefore IRT can be suggested as an objective tool for diagnosis and monitoring of disease.
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Affiliation(s)
- Giorgia Martini
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Michela Cappella
- Pediatric Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Roberta Culpo
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Fabio Vittadello
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Francesco Zulian
- Pediatric Rheumatology Unit, Department of Woman and Child Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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Vounotrypidis P, Pyrpasopoulou A, Sakellariou GT, Zisopoulos D, Kefala N, Oikonomou DI, Stefanis C, Aslanidis S, Bermperidis C, Pappas P. Vascular acrosyndromes in young adult population. Definition of clinical symptoms and connections to joint hypermobility. Clin Rheumatol 2019; 38:2925-2932. [PMID: 31177398 DOI: 10.1007/s10067-019-04627-w] [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: 02/24/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Clinical recognition of vascular acrosyndromes is often challenging. The term Raynaud's phenomenon (RP) is commonly overused to describe any form of cold-related disorder. This study aims to formally evaluate peripheral vascular symptoms affecting the population, aged ≤ 40 years, and identify any correlations to joint hypermobility (JH). PATIENTS AND METHODS Fifty patients (31 males, 19 females) with vasomotor symptoms enrolled in this five-year prospective observational study. Clinical examination by a rheumatologist and a vascular surgeon was performed along with cardiology, echocardiographic and Doppler evaluation. Patients underwent blood cell count, biochemistry, thyroid and selectively immunologic testing. Twenty-four (48%) of them performed nailfold capillaroscopy. The SPSS for Windows, v.17.0, Chicago, USA, was used for the statistical analyses. RESULTS Twenty-eight patients (56%) presented with erythromelalgia (EM), 6 (12%) with acrocyanosis (AC) and 9 (18%) as a combination of the above disorder. RP diagnosed in five (10%) while two patients (4%) presented as a mix of EM-RP. There was no correlation with abnormal laboratory tests. Increased incidence of JH was found in EM and AC patients. Among those who were tested with nailfold capillaroscopy, 75% had abnormalities ranged from mild to autoimmune-like diseases. CONCLUSIONS Erythromelalgia is the commonest functional vasculopathy in young population followed by acrocyanosis and a combination of these conditions. Joint hypermobility is markedly increased, indicating that dysautonomy may be considered the causative factor following a trigger event. Overall, RP was observed in 14% of patients. Clinical recognition of these disorders avoids unnecessary investigation. Key Points • Vascular acrosyndromes in young adults are commonly functional disorders resembling vascular algodystrophy induced by thermic stress. • Dysautonomy of joint hypermobility is the co-factor influencing the appearance of the vascular disorders. • Raynaud's phenomenon accounts to approximately 14% of vascular acrosyndromes presented in the young adult population.
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Affiliation(s)
- Periklis Vounotrypidis
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece.
| | - Athina Pyrpasopoulou
- 2nd Propaedeutic Clinic, Department of Internal Medicine, "Ippokration" Hospital, Thessaloniki, Greece
| | - Grigorios T Sakellariou
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Dimitrios Zisopoulos
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Nikoleta Kefala
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Dimitrios I Oikonomou
- Department of Immunology and Microbiology, 424 General Military Hospital, Thessaloniki, Greece
| | | | - Spyros Aslanidis
- 2nd Propaedeutic Clinic, Department of Internal Medicine, "Ippokration" Hospital, Thessaloniki, Greece
| | - Charalambos Bermperidis
- Rheumatology Department, 424 General Military Hospital, Nea Efkarpia, 56249, Thessaloniki, Greece
| | - Periklis Pappas
- Vascular Surgery Department, 424 General Military Hospital, Thessaloniki, Greece
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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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26
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Bergersen TK, Walløe L. Acral coldness - severely reduced blood flow to fingers and toes. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:677-685. [PMID: 30459032 DOI: 10.1016/b978-0-444-64074-1.00040-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The term acral coldness is used to describe physiologic or pathologic situations in humans where the fingers and toes are exceptionally cold in spite of normal central body temperature. In the thermoneutral zone, the blood flow to acral skin normally shows large fluctuations between high and low values, with a frequency of about 3 cycles per minute. At an acral skin temperature of about 21°C, finger blood flow is constantly low. At lower temperatures the fingers and toes become painful. This is a normal physiologic reaction, probably because of ischemia. The characteristics of the most frequent acral vascular syndromes, Raynaud phenomenon, acrocyanosis, and chilblains, are discussed. Common to all three is pathologically low blood flow and disappearance of physiologic fluctuations even in the thermoneutral zone. Ischemic vascular diseases in acral skin are usually diagnosed from clinical observations. Measurements of fluctuating blood flow by laser or ultrasound Doppler could be useful, but should be carried out at a room temperature of 24-25°C.
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Affiliation(s)
- Tone Kristin Bergersen
- Department of Dermatology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Walløe
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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27
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Abstract
In the contemporary era of medical diagnosis via sophisticated radiographic imaging and/or comprehensive serological testing, a focused physical examination remains paramount in recognizing the cutaneous manifestations of chronic vascular disease. Recognition of the unique cutaneous signs of lymphatic and venous hypertension assists in the diagnosis as well as the staging and classification of both lymphedema and chronic venous insufficiency. Awareness of explicit dermatologic vasomotor manifestations aids not only in the identification of acrocyanosis, Raynaud phenomenon, pernio, and erythromelalgia but also mitigates confusion related to their clinical overlap. Although the clinical signs of peripheral artery disease are not necessarily specific or sensitive, a knowledge of suggestive dermatologic findings is helpful in recognition of severe limb ischemia. A brief review of the epidemiology, etiology, pathogenesis, and therapy of cutaneous related chronic vascular disease follows including an emphasis on characteristic clinical features supported by illustrative photographs.
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Affiliation(s)
- Steven M Dean
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH.
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28
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Abstract
BACKGROUND Peripheral vascular abnormalities caused by a dysregulation between peripheral vasoconstriction and vasodilatation, clinically appearing with Raynaud's phenomenon, have been described in anorexia nervosa but specific characteristics of microcirculation in anorexic patients have not yet been studied. METHODS We performed nailfold videocapillaroscopy to assess microcirculatory alteration in anorexic patients and found three different patterns: normal, aspecific and early scleroderma pattern. We also evaluated several laboratory and clinical parameters to better assess our capillaroscopic findings. RESULTS None of the clinical parameters examined correlated with specific capillaroscopic findings. An increased risk of autoimmune diseases in eating disorder patients has been described. Our results evidenced an association between early scleroderma capillaroscopic pattern and Raynaud's phenomenon that occurs in anorexia nervosa patients, whereas no significant association was found between all three capillaroscopic patterns and the presence of autoantibodies, as well as ESR and CRP values. CONCLUSIONS Our study reveals that patients with AN suffering from RP exhibit NVC findings typical of connective tissue diseases.
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Affiliation(s)
- Massimo De Martinis
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
| | - Maria Maddalena Sirufo
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
| | - Lia Ginaldi
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
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29
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Wollina U, Koch A, Langner D, Hansel G, Heinig B, Lotti T, Tchernev G. Acrocyanosis - A Symptom with Many Facettes. Open Access Maced J Med Sci 2018; 6:208-212. [PMID: 29484025 PMCID: PMC5816301 DOI: 10.3889/oamjms.2018.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/18/2023] Open
Abstract
Acrocyanosis is an uncommon complaint belonging to the acro-syndromes. It typically presents with coolness and bluish discolourations of hands, feet, ears, nose, lips and nipple. The most frequently affected parts of the body are the hands. This review discusses physical factors, vascular disorders, infectious diseases, haematological disorders, solid tumours genetic disorders, drugs, eating disorders, and spinal disease presenting as or leading to acrocyanosis.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - André Koch
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Dana Langner
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Gesina Hansel
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Birgit Heinig
- Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden, Germany
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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Rigante D, Fastiggi M, Ricci F, D'Errico F, Bracci B, Guerriero C. Handy Hints About Raynaud's Phenomenon in Children: A Critical Review. Pediatr Dermatol 2017; 34:235-239. [PMID: 28523890 DOI: 10.1111/pde.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Raynaud's phenomenon (RP) is a vasospastic disorder characterized by recurrent self-limited episodes of skin pallor, cyanosis, and hyperemia caused by paroxysmal spasms in the small arteries of the fingers and toes and can occur in any age group. Hands, feet, nose, ears, and nipples can be affected. The diagnosis is made clinically, assessing varying degrees of ischemia in the involved areas of skin, but this transient ischemia may also herald the onset of connective tissue disease. Investigation is recommended when RP starts in childhood to exclude an underlying autoimmune condition and close follow-up for its development. Management of RP in children includes conservative and pharmacologic treatments.
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Affiliation(s)
- Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Michele Fastiggi
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Francesco Ricci
- Institute of Dermatology, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Francesca D'Errico
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Benedetta Bracci
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Cristina Guerriero
- Institute of Dermatology, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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31
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Miranda S, Lévesque H. [Acrocyanosis: A common but poorly understood condition]. Rev Med Interne 2017; 38:225-227. [PMID: 28242038 DOI: 10.1016/j.revmed.2017.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 12/22/2022]
Affiliation(s)
- S Miranda
- Normandie université, UNIROUEN, U1096, service de médecine interne, 76000 Rouen, France
| | - H Lévesque
- Normandie université, UNIROUEN, U1096, service de médecine interne, 76000 Rouen, France.
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32
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Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: A systematic review. Int J Eat Disord 2016; 49:238-48. [PMID: 26710932 DOI: 10.1002/eat.22481] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Anorexia nervosa portends the highest mortality among psychiatric diseases, despite primarily being a disease of adolescents and younger adults. Although some of this mortality risk is attributable to suicide, many deaths are likely cardiovascular in etiology. Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased mortality. Given limited prevalence of severe anorexia there is a paucity of clinical and autopsy data to discern an exact cause of death. METHODS Given this background we conducted a systematic review of the medical literature to provide a contemporary summary of the pathobiologic sequelae of severe anorexia nervosa on the cardiovascular system. We sought to elucidate the impact of anorexia nervosa in four cardiovascular domains: structural, repolarization/conduction, hemodynamic, and peripheral vascular. RESULTS A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility. Despite the prevalent theory that malignant arrhythmias are implicated as a cause of sudden death in this disorder, data to support this causal relationship are lacking. DISCUSSION It is reasonable to obtain routine electrocardiography and measurements of orthostatic vital signs in patients presenting with anorexia nervosa. Echocardiography is generally not indicated unless prompted by clinical signs of disease. Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope.
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Affiliation(s)
- Katherine V Sachs
- Department of Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Denver, Aurora
| | - Ben Harnke
- Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philip S Mehler
- Department of Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Denver, Aurora
| | - Mori J Krantz
- University of Colorado School of Medicine, Denver, Aurora.,Division of Cardiology, Denver Health Medical Center, Denver, Colorado
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33
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Affiliation(s)
- Hiroki Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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34
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Kordzadeh A, Caine PL, Jonas A, Rhodes KM, Panayiotopolous YP. Is Achenbach's syndrome a surgical emergency? A systematic review. Eur J Trauma Emerg Surg 2015; 42:439-443. [PMID: 26669687 DOI: 10.1007/s00068-015-0610-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/19/2015] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study is to establish the nature (urgent vs. non-urgent), demographics, presentation and management of Achenbach's syndrome and to formulate an algorithmic approach for their diagnosis and management. MATERIALS AND METHODS A systematic review and met-aggregation of literature from 1944 to 2015 in English language in MedLine, Embase and Cochrane database were conducted. RESULTS Achenbach's syndrome is a female-dominant disease with median age of 49.5 years (range 22-76) (age ≤60, n = 11/12, 91 %). It presents with unilateral volar discoloration of a finger (100 %). It is associated with pain (n = 7/12, 58. %), edema (n = 7/12, 58 %), and paresthesia (n = 3/12, 25 %). The median time to resolution of symptoms without any intervention was 4 days (range 2-14). CONCLUSION AS is self-limiting and a non-urgent surgical condition. It can be differentiated from other pathologies by clinical spectrum, patient demographics and in doubtful circumstances (acute limb ischemia) by Doppler sonography. An algorithmic approach can avoid hospital admissions, partially unnecessary investigation and assist in patient assurance.
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Affiliation(s)
- A Kordzadeh
- Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Essex, UK.
| | - P L Caine
- Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Essex, UK
| | - A Jonas
- Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Essex, UK
| | - K M Rhodes
- Department of Accident and Emergency, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Court Road, Essex, CM1 7ET, UK
| | - Y P Panayiotopolous
- Department of Vascular and Endovascular Surgery, Mid Essex Hospital Services NHS Trust, Essex, UK
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