A recent case report published in The Journal of Emergency Medicine highlights a case of Raynaud’s phenomenon associated with systemic lupus erythematosus in a patient who presented to the emergency department with discoloration and pain in her right index finger after a minor trauma.
The report, “Post-Traumatic Raynaud’s Phenomenon: A Case Report,” tells the case of an otherwise healthy 41-year-old Chinese woman who arrived in the emergency department complaining of pain and discoloration in her right index finger that had endured for about two months. The patient reported that the pain began after inadvertently catching her hand in a metal cupboard at work.
One month after the injury, the woman visited a hand specialist who diagnosed her with transient nerve injury (neuropraxia) secondary to contusion.
However, when the patient’s pain and discoloration persisted, she visited the emergency department, where physicians noted discoloration over several fingertips on both hands, and hyperpigmented, scaly-plaques on her forehead suggestive of underlying systemic disease. She was diagnosed with Raynaud’s phenomenon with possible underlying systemic disease, and admitted to the hospital for further evaluation.
The patient underwent vascular studies, including capillaroscopy and photoplethysmography, which are frequently abnormal in cases of occupational-related Raynaud’s phenomenon. However, the results were all normal in this patient, making a secondary cause of Raynaud’s phenomenon more likely, such as underlying autoimmune disease.
The patient eventually was diagnosed with the autoimmune disease systemic lupus erythematosus with complex regional pain syndrome. She was started on immunosuppressants, including hydroxychloroquine and prednisone, and was discharged one week later.
Although the exact pathogenesis of Raynaud’s phenomenon is still poorly understood, secondary causes include autoimmune diseases such as rheumatoid arthritis, scleroderma and also lupus.
The authors emphasized that although the patient did report a history of minor trauma preceding the onset of pain and discoloration, she did not have any obvious occupational-related risk factors that may have predisposed her to developing Raynaud’s.
“This case illustrates a common presenting complaint to the ED [emergency department] with an unexpected final diagnosis. The symptoms could have been easily attributed to chronic pain from the initial trauma and repetitive stress and treated with analgesia. However, the presence of discoloration over the affected finger as well as the uninjured fingers should prompt the emergency physician to look for other causes.” the team wrote.
“It is important to diagnose Raynaud’s phenomenon because of its potential complications. If left untreated, it can lead to ulcerations of the fingers and eventually necrosis and gangrene.” the team concluded.