Abstract
A 65-year-old man presented to our clinic in autumn with a 5-year history of painful purple digits that recovered with rewarming (Panel A). His skin changes developed when the temperature was below 20°C. He had not smoked for 20 years, and annual health checkup results were unremarkable (these included normal blood sugar and cholesterol levels). Raynaud phenomenon was suspected. He was subsequently hospitalized in the winter due to ischemic digital gangrene (Panel B). Laboratory evaluation revealed renal failure, elevated serum immunoglobulin G (IgG), low IgM and IgA, low C4, and the presence of cryoglobulins and monoclonal IgG-κ. Results were negative for antibodies to hepatitis B and C virus, antinucleolar antibody, anti-Ro antibody, and anti-La antibody. A bone marrow biopsy was performed and he was diagnosed with type I cryoglobulinemia due to multiple myeloma. Treatment with conservative amputation and chemotherapy was initiated, and the ischemic skin changes completely resolved.
The differential diagnoses of painful purple digits suggesting arterial thromboembolism can be divided into two groups: those associated with cold temperature exacerbation (malignancy, cryoglobulinemia, small-vessel vasculitis, secondary vasculitis, systemic sclerosis, antiphospholipid syndrome, and Buerger’s disease) and those independent of temperature (embolus of infectious or thrombotic material from endocarditis, paradoxical embolus through an intracardiac shunt, thrombotic thrombocytopenic purpura, heparin-induced thrombocytopenia, and cholesterol emboli).1,2 These diseases can lead to ischemic digital gangrene; thus, prompt evaluation of patients with acrocyanosis or Raynaud phenomenon is essential to prevent further complications.
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Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.