School of Medicine and Health Sciences Poster Presentations
An Unusual Case of A Blue Finger
Poster Number
190
Document Type
Poster
Publication Date
3-2016
Abstract
Introduction:
Acute discoloration and paresthesia of a distal extremity is concerning for an ischemic event or a manifestation of underlying systemic disease. Achenbach syndrome is an infrequent, but benign etiology of an acute blue finger that needs to be recognized clinically. We present a case to increase awareness.
Case:
A 57-year-old Caucasian female presented to rheumatology clinic for "bruising digits.” She described four episodes of spontaneous segmental, blue discoloration of varying digits over the past two years. Each episode was isolated to a single digit and preceded by 10-15 minutes of throbbing with the digit then turning white and numb. These prodromes were followed by a feeling of “blood vessel popping” with subsequent "bruising" and mild swelling. Resolution of discoloration ranged from several hours to several days. There was no association with exposure to cold temperatures and warming the fingers would not alleviate the symptoms, nor abort the course. Past medical history includes Raynaud’s disease diagnosed in her twenties. Her current symptoms feel distinctly different from usual Raynaud’s episodes. She is a non-smoker and takes no medications. Family history is non-contributory.
Physical exam was unremarkable at presentation and follow up. Photos from the recent episode were available, revealing blue discoloration involving the volar surface of the right 3rd digit at the PIP extending 1cm on either side of the joint with mild swelling, sparing of the distal phalange and no abnormalities of the surrounding digits.
Work-up for Raynaud’s included anti-nuclear antibodies and its sub-serologies, anti-phospholipid serologies, complements, complete blood count and complete metabolic panel. These studies were unremarkable and no autoimmune process was identified. The patient also underwent MRA of the right upper extremity, which was non-revealing. Based on the clinical presentation, a diagnosis of Achenbach syndrome was made and the patient was reassured.
Discussion:
Achenbach syndrome is a benign, self-limiting cause of spontaneous blue finger discoloration that is commonly misdiagnosed as vascular problems, including Raynaud’s. Unlike Achenbach syndrome, Raynaud’s episodes may involve multiple fingers simultaneously, is temperature related and warrants further work-up. In contrast, case studies and case series of Achenbach syndrome suggest futility of angiography and extensive rheumatologic work-up and have not demonstrated any significant disease associations over time. Despite the concerns raised by acuity and appearance, knowledge of Achenbach syndrome along with careful history taking will direct the physician to the correct diagnosis and avoid unnecessary, costly testing.
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Open Access
1
An Unusual Case of A Blue Finger
Introduction:
Acute discoloration and paresthesia of a distal extremity is concerning for an ischemic event or a manifestation of underlying systemic disease. Achenbach syndrome is an infrequent, but benign etiology of an acute blue finger that needs to be recognized clinically. We present a case to increase awareness.
Case:
A 57-year-old Caucasian female presented to rheumatology clinic for "bruising digits.” She described four episodes of spontaneous segmental, blue discoloration of varying digits over the past two years. Each episode was isolated to a single digit and preceded by 10-15 minutes of throbbing with the digit then turning white and numb. These prodromes were followed by a feeling of “blood vessel popping” with subsequent "bruising" and mild swelling. Resolution of discoloration ranged from several hours to several days. There was no association with exposure to cold temperatures and warming the fingers would not alleviate the symptoms, nor abort the course. Past medical history includes Raynaud’s disease diagnosed in her twenties. Her current symptoms feel distinctly different from usual Raynaud’s episodes. She is a non-smoker and takes no medications. Family history is non-contributory.
Physical exam was unremarkable at presentation and follow up. Photos from the recent episode were available, revealing blue discoloration involving the volar surface of the right 3rd digit at the PIP extending 1cm on either side of the joint with mild swelling, sparing of the distal phalange and no abnormalities of the surrounding digits.
Work-up for Raynaud’s included anti-nuclear antibodies and its sub-serologies, anti-phospholipid serologies, complements, complete blood count and complete metabolic panel. These studies were unremarkable and no autoimmune process was identified. The patient also underwent MRA of the right upper extremity, which was non-revealing. Based on the clinical presentation, a diagnosis of Achenbach syndrome was made and the patient was reassured.
Discussion:
Achenbach syndrome is a benign, self-limiting cause of spontaneous blue finger discoloration that is commonly misdiagnosed as vascular problems, including Raynaud’s. Unlike Achenbach syndrome, Raynaud’s episodes may involve multiple fingers simultaneously, is temperature related and warrants further work-up. In contrast, case studies and case series of Achenbach syndrome suggest futility of angiography and extensive rheumatologic work-up and have not demonstrated any significant disease associations over time. Despite the concerns raised by acuity and appearance, knowledge of Achenbach syndrome along with careful history taking will direct the physician to the correct diagnosis and avoid unnecessary, costly testing.
Comments
Presented at: GW Research Days 2016