Giglio Mariateresa, Preziosa Angela, Rekatsina Martina, Viswanath Omar, Urits Ivan, Varrassi Giustino, Paladini Antonella, Puntillo Filomena
Department of Anaesthesiology, University of Bari Aldo Moro, Bari, ITA.
Department of Anesthesiology, University of Bari Aldo Moro, Bari, ITA.
Cureus. 2021 Apr 19;13(4):e14569. doi: 10.7759/cureus.14569.
Necrotizing Raynaud's phenomenon is a vascular clinical syndrome characterized by vasospasm of distal resistance vessels, usually triggered by cold temperatures or by psychological conditions such as anxiety and stress. Pain is the first reported symptom, related to insufficient oxygen delivery to the extremities that leads to ischemia of the peripheral tissues. The initial treatment is conservative, but if the symptoms persist, necrosis and distal amputation can occur. In selected patients, neuromodulation with spinal cord stimulation (SCS) can be an effective treatment by reducing pain and amputation rate. Recent evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause endotheliopathy with microvascular and macrovascular thrombotic events and can present as a systemic inflammatory vascular disease. We present a case of a severe necrotizing Raynaud's phenomenon successfully treated and controlled with SCS that abruptly reappeared during SARS-CoV-2 infection. The report of this case is suggestive for potential treatment in case of peripheral ischemia consequent to COVID-19 vasculopathy. The interaction between SCS and SARS-CoV-2-related endotheliopathy is unknown and would deserve further studies.
坏死性雷诺现象是一种血管临床综合征,其特征为远端阻力血管痉挛,通常由寒冷温度或焦虑、压力等心理状况引发。疼痛是首个被报道的症状,与肢体氧气供应不足导致外周组织缺血有关。初始治疗是保守的,但如果症状持续,可能会发生坏死和远端截肢。在特定患者中,脊髓刺激(SCS)神经调节可通过减轻疼痛和降低截肢率成为一种有效的治疗方法。最近的证据表明,严重急性呼吸综合征冠状病毒2(SARS-CoV-2)可导致伴有微血管和大血管血栓形成事件的内皮病变,并可表现为一种全身性炎症性血管疾病。我们报告一例严重坏死性雷诺现象患者,该患者经SCS成功治疗并得到控制,但在感染SARS-CoV-2期间该现象突然再次出现。该病例报告提示了针对COVID-19血管病变导致的外周缺血的潜在治疗方法。SCS与SARS-CoV-2相关内皮病变之间的相互作用尚不清楚,值得进一步研究。
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