Acrocyanosis due to cold agglutinins in a patient with rheumatoid arthritis.

摘要

We noted the recent report of drug-induced acrocyanosis and wish to report a patient with acrocyanosis as part of rheumatoid disease.An 89-year-old woman was admitted to our department with fatigue, low grade fever of 4 months duration, and exertional dyspnea, which had been worse during the last month. Her medical history was unremarkable except for morning stiffness for more than 1 hour and episodes of arthritis at both hands during the last few years. The patient had also noticed gray discoloration of her fingers during the previous winter and upon exposure to cold water. On admission, the patient had low grade fever of 37.2degC, and the clinical examination revealed swelling with concomitant mild pain with moderate limitation of motion in proximal inter-phalangeal and metacarpophalangeal joints of both hands. In addition, the fingers had gray to purplish discoloration without ulceration or reactive hyperemia of Raynaud phenomenon, while arterial pulses were normal, a clinical picture that was compatible with acrocyanosis. There was no lymphadenopa-thy or splenomegaly. Laboratory findings included: Hematocrit: 31%, white blood cell: 8110/mm, erythrocyte sedimentation rate: 82 mm/lsth (<50 mm/lsth), C-reactive protein: 52 mg/L (<10 mg/L), lactic dehydrogenase: 350 IU/L (<280 IU/L), rheumatoid factor: 35 IU/L (<25 IU/L).