Stammler F, Lawall H, Diehm C
Klinik für Innere Medizin, Sanakrankenhaus Wildbad, Bad Wildbad.
Dtsch Med Wochenschr. 2003 Sep 5;128(36):1825-8. doi: 10.1055/s-2003-41967.
A 38-year-old woman, in her 13th week of pregnancy, presented for angiological investigation of repeated episodes of pain in the right index finger. She also reported painful paleness of the right nipple evoked particularly by cold. This was her fifth pregnancy; she had miscarried twice. The nipple pain occurred spasmodically and in three phases, while the left nipple was unaffected. The attacks lasted c. 15 min, progressing from an ischemic to a hyperemic phase, accompanied by unbearable pain. When first examined there was circumscribed, purplish network-patterned discoloration of the right hand with blackened discoloration of the distal nail-bed of the index finger.
Duplex-sonography revealed patency of the large arteries of the arm and hand. Transesophageal echocardiography showed a persistent foramen ovale and echo-density suspected to be a right atrial thrombus. Laboratory tests demonstrated anticardiolipin antibodies, suggesting an antiphospholipid syndrome.
On administration of low-molecular heparin, its dosage weight-adjusted, and 100 mg aspirin daily the discoloration of the finger quickly disappeared, but Raynaud's syndrome remained unchanged until she had stopped breast feeding (left breast only) after 8 months. A healthy girl had been delivered by cesarean section in the 39th week, weighing 3100 g. There were no further thromboembolic complications.
This very rare case of Raynaud's phenomenon in a nipple was associated with an anti-phospholipid syndrome.
一名38岁女性，孕13周，因右手食指反复疼痛前来进行血管学检查。她还报告说右乳头遇冷时会出现疼痛性苍白。这是她的第五次怀孕；她曾两次流产。乳头疼痛呈痉挛性，分三个阶段，而左乳头未受影响。发作持续约15分钟，从缺血期发展到充血期，伴有难以忍受的疼痛。初诊时，右手有局限性紫色网状变色，食指远端甲床发黑。
双功超声显示手臂和手部大动脉通畅。经食管超声心动图显示卵圆孔未闭以及疑似右心房血栓的回声密度。实验室检查显示存在抗心磷脂抗体，提示抗磷脂综合征。
给予低分子肝素，根据体重调整剂量，并每日服用100毫克阿司匹林后，手指变色很快消失，但雷诺综合征直到她8个月后停止母乳喂养（仅左侧乳房）前都没有变化。第39周时通过剖宫产分娩出一名健康女婴，体重3100克。没有进一步的血栓栓塞并发症。
这种非常罕见的乳头雷诺现象病例与抗磷脂综合征有关。
