A 39-year-old male came to the consultation, with no personal history of interest except subclinical hypothyroidism. In addition, primary care for evaluation of lesions colored in our zones were referred to as bloating, persistent in both environments.
No family history of interest was found.
The patient was not taking any vasoconstrictor medication.
Physical examination revealed extreme coldness and coloration in the distal extremities of both hands in a very symmetrical way. The most notable changes were in the second, third and fourth fingers.
Distal pulses were preserved, and there were no other involved anatomical areas.
No sclerodactyly, punctiform trics or other significant findings suggestive of scleroderma were observed.
Cardiopulmonary examination revealed no abnormalities.
Several complementary, analytical and imaging tests were performed.
Blood count, electrolytes, coagulation, liver function, renal function and normal blood gas, urine tumor markers, erythrocyte sedimentation rate, complement levels, immunoglobulins, cryoagglutinins, cryoglobulins
A thyroid function study revealed subclinical hypothyroidism with normal antithyroglobulin and antiperoxidase antibodies.
Serology for HBV, HCV, HIV and syphilis were negative.
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The immunological study revealed positive ANA titer 1/2560 with negative anti-DNA, ENA, anticardiolipin, scl70, anticentromere and rheumatoid factor antibodies.
Chest CT was rigorously normal.
Two months later the patient began to present sclerodactyly and cervical punctiforms in finger pulps and induration of pre-existing skin and lateroscopic region.
Treatment was initiated with pentoxyphylline, descending oral corticosteroids and azathioprine, with good control of the disease.
