Digit Amputation Secondary to COVID-19-Induced Raynaud's Phenomenon

Raynaud's phenomenon (RP) is characterized by episodic vasospasm of the small blood vessels, primarily affecting the fingers and toes. Management includes lifestyle modifications, pharmacological treatments, and in severe cases, surgical interventions. Here we report a case of an 80-year-old male patient with a history of hypertension, dyslipidemia, obesity, and atrial fibrillation who presented to the emergency department with edema, cyanosis, and intense pain in the fingers of both hands following a mild COVID-19 infection (no dyspnea or hypoxemia). Despite stable vital signs and an otherwise unremarkable physical exam, laboratory tests revealed leukocytosis, elevated inflammatory markers, and signs of local infection. Consequently, he was admitted to the ward on antibiotics (amoxicillin/clavulanic acid), nifedipine for vasodilation, and opioids for pain control. However, his condition deteriorated, with progressive necrosis necessitating escalation of therapy to iloprost infusion and bosentan. The right hand showed no improvement, and surgical intervention was planned around wound care aimed at mummification and subsequent amputation. The left hand gradually improved with continued medication. During hospitalization, serologic testing and nailfold capillaroscopy did not reveal any secondary causes such as connective tissue diseases. Imaging studies ruled out underlying neoplasia and thrombosis. The patient was diagnosed with severe Raynaud's phenomenon, potentially triggered by the recent COVID-19 infection, a phenomenon already described in case reports. This case underscores the potential impact of COVID-19 as a precipitating factor for severe Raynaud's phenomenon, particularly in elderly patients with comorbidities. The rapid progression and refractory nature of the condition highlight the need for early recognition and aggressive management.