A case report of severe Raynaud’s phenomenon in a black-African woman illustrates the difficulties clinicians still face for diagnosis and management.
The report, “Difficulties in diagnosis and treatment of severe secondary Raynaud’s phenomenon in a Cameroonian woman: a case report,” was published in the Journal of Medical Case Reports.
The patient, a 43-year-old female Cameroonian farmer, entered the emergency room presenting the following symptoms: Pain, ulceration, and “darkening” of her fingers and feet over a period of two days. The patient’s medical history included a seven-year history of episodic paresthesia (a burning or prickling sensation) in her fingers and toes when exposed to cold, particularly cold weather and immersion of hands in cold water.
Additional examination revealed signs of bilateral ulceration and dry gangrene of her fingers and toes. Gangrene death of a tissue is caused by a critically insufficient blood supply.
Clinicians gave a diagnosis of severe secondary Raynaud’s phenomenon caused by a connective tissue disease.
Raynaud’s manifests as two types of conditions, primary and secondary. Primary Raynaud’s, also called Raynaud’s disease, is the most common form with a prevalence of 3-5% predominantly in cold climates, and is not linked to any additional underlying medical condition. Secondary Raynaud’s, also known as Raynaud’s phenomenon, is associated to an underlying health condition. Although less common when compared to primary Raynaud’s, secondary Raynaud’s often is more serious.
The patient was submitted to pharmacological therapy, which included nifedipine, sildenafil, cloxacillin, and tramadol. Within 45 minutes of treatment, the patient felt no more pain. After three days of care, the patient was stable and was referred to a rheumatologist to continue disease monitoring.
Additional non-pharmacological measures during patient treatment included warm clothing and using lukewarm water for hands and feet. The patient also avoided consumption of products with caffeine, cold exposure, and smoking (both active or second-hand).
“We have presented a case of severe secondary RP [Raynaud’s phenomenon] in a black African woman from a resource-limited setting. Early diagnosis of this condition and appropriate management is pivotal to prevent tissue necrosis and amputation of the affected digits in extreme cases. The classical biphasic color change during crisis should not be solely relied on to make the diagnosis of RP in black Africans,” the authors concluded.