Abstract
An 84-year-old man presented with severe redness and acrocyanosis (Panel A) affecting his hands and feet, predominantly exacerbated during colder months, leading to significant discomfort, though without ulceration or other complications.1,2 A comprehensive rheumatologic evaluation showed no evidence of systemic autoimmune disease, with all immunological markers and inflammatory indices within normal limits. In April 2024, the patient underwent nailfold capillaroscopy for the first time at our center. The examination revealed mildly disorganized architecture with predominantly stubby and tortuous capillaries, alongside decreased capillary density and several dilated capillary loops (Panel B, arrows). No microbleeds were noted, and no megaloops were observed (bubble visible in Panel B-2 is air and oil). 3 Written informed consent was obtained from the patient for publication of this case.
These findings suggest a microvascular fragility pattern that could be related to age rather than an underlying autoimmune disorder. The nailfold capillaries exhibited both blunted and tortuous morphology, which are characteristic of disturbances in microcirculation associated with acrocyanosis. 4 In our clinical case involving a patient with acrocyanosis, we observed marked tortuosity of the capillaries, a feature notably absent in the control subject, an 80-year-old man without acrocyanosis (Panel C). In the control, the capillary loops exhibited a normal morphology, with no significant evidence of tortuosity or enlargement. This distinct variation highlights the specific microvascular alterations associated with acrocyanosis compared to unaffected individuals.
Current literature lacks formal diagnostic criteria for capillaroscopic findings in acrocyanosis, making this case particularly valuable for enhancing our understanding of microvascular changes in elderly patients experiencing cold-induced cyanosis. 5 The integration of capillary observations into the diagnostic process, including the analysis of density, morphology, and the presence of structural abnormalities, adds crucial insight into the potential pathophysiological mechanisms underlying this condition. The images presented provide an instructive example of how capillaroscopy can highlight age-related vascular changes in nonautoimmune acrocyanosis.
These imaging findings underscore the need for further study into capillaroscopic features of acrocyanosis, especially in isolated cases involving elderly patients. Future research with larger cohorts may help determine if these capillaroscopic changes are unique to severe acrocyanosis or indicative of a broader spectrum of microvascular fragility in the aging population.
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
