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[Digital necrosis of the arm excluding scleroderma. Retrospective study of 45 cases]
N Cailleux1, H Levesque, P Gilbert
1Service de Médecine Interne-Angéiologie, Hôpital de Boisguillaume, Centre Hospitalier Universitaire, Rouen.
Insights
Digital necrosis is a medical emergency with diverse causes, often linked to connective tissue diseases in women and varied arterial or local issues in men. This study excluded Progressive Systemic Sclerosis to explore other etiologies.
Area of Science:
- Vascular Medicine
- Rheumatology
- Internal Medicine
Context:
- Digital necrosis, a critical condition, presents diverse etiologies.
- Progressive Systemic Sclerosis (PSS) is a common cause in women, necessitating exclusion for broader etiological investigation.
- Understanding non-PSS causes is crucial for accurate diagnosis and management.
Purpose:
- To retrospectively identify and categorize the causes of digital necrosis in patients without Progressive Systemic Sclerosis.
- To analyze the etiological spectrum of digital necrosis in a cohort excluding PSS.
- To differentiate causes based on sex and clinical presentation.
Summary:
- A retrospective review of 45 patients (10 women, 35 men) without PSS admitted for digital necrosis was conducted.
- In women, causes included atherosclerosis, paraneoplastic syndrome, thrombocythemia, and various connective tissue diseases. Men presented with arterial diseases (thromboangiitis obliterans, atherosclerosis), local syndromes (hammer's, thoracic outlet), cardiac embolism, antiphospholipid syndrome, and other connective tissue diseases.
- A significant portion of causes remained diverse, with 4 patients (3 smokers) having an undetermined etiology, highlighting the complexity of digital necrosis.
Impact:
- This study broadens the understanding of digital necrosis beyond PSS, particularly in men.
- It emphasizes the need for comprehensive diagnostic workups, including vascular, cardiac, and autoimmune assessments.
- Findings aid in refining differential diagnoses and guiding further research into less common causes of digital necrosis.
Unlabelled:
The causes of digital necrosis are so diverse that it should be considered not as a surgical but as a medical emergency. In women, digital necrosis first suggests connective tissue disease, and especially Progressive Systemic Sclerosis. In men the causes are more diverse. In this retrospective study, we have tried to identify and categorize the cause of digital necrosis in patients without Progressive Systemic Sclerosis. The medical files of all patients admitted from 1/1/89 to 1/1/93 for digital necrosis were retrospectively reviewed. All patients with Progressive Systemic Sclerosis, either diagnosed at that time or know before, were excluded. All 45 patients in the study had an evaluation of coagulation, vascular risk factors, a cardiac examination and nailfold capillary microscopy, as well as tests for antinuclear antibodies, and cryoglobulinaemia. Other tests were done according to the clinical presentation. Upper limb angiography was done 26 times.
Results:
there were 10 women and 35 men, mean age 53 years (24-85 years). In the women, the following diagnosis were found: atherosclerosis 1, paraneoplastic syndrome 1, one thrombocythemia, and 6 connective tissue diseases (one dermatopolymyositis, 1 essential cryoglobulinaemia, 2 lupus erythematous and two suspected secondary Raynaud's phenomenon. Twelve men had arterial diseases: 6 thromboangiitis obliterans and 6 obliterans atherosclerosis. Seven times, the cause was local: 5 hammer's syndromes, 2 thoracic outlet syndrome. In the other patients, the causes were extremely diverse: cardiac embolism (4), primary antiphospholipid syndrome (3), polyarteritis nodosa (1), leprosy seroconversion (1), connective tissue disease (3). In 4 patients (3 of whom were smokers) no cause was found.(ABSTRACT TRUNCATED AT 250 WORDS)