Carvalho Rui, Subtil Joana, Macedo Brás Elisa, Campos Jacinta, Silva Renata
Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Vascular Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Cureus. 2024 Dec 22;16(12):e76204. doi: 10.7759/cureus.76204. eCollection 2024 Dec.
Raynaud's phenomenon (RP) is characterized by episodic vasospasm of the small blood vessels, primarily affecting the fingers and toes. Management includes lifestyle modifications, pharmacological treatments, and in severe cases, surgical interventions. Here we report a case of an 80-year-old male patient with a history of hypertension, dyslipidemia, obesity, and atrial fibrillation who presented to the emergency department with edema, cyanosis, and intense pain in the fingers of both hands following a mild COVID-19 infection (no dyspnea or hypoxemia). Despite stable vital signs and an otherwise unremarkable physical exam, laboratory tests revealed leukocytosis, elevated inflammatory markers, and signs of local infection. Consequently, he was admitted to the ward on antibiotics (amoxicillin/clavulanic acid), nifedipine for vasodilation, and opioids for pain control. However, his condition deteriorated, with progressive necrosis necessitating escalation of therapy to iloprost infusion and bosentan. The right hand showed no improvement, and surgical intervention was planned around wound care aimed at mummification and subsequent amputation. The left hand gradually improved with continued medication. During hospitalization, serologic testing and nailfold capillaroscopy did not reveal any secondary causes such as connective tissue diseases. Imaging studies ruled out underlying neoplasia and thrombosis. The patient was diagnosed with severe Raynaud's phenomenon, potentially triggered by the recent COVID-19 infection, a phenomenon already described in case reports. This case underscores the potential impact of COVID-19 as a precipitating factor for severe Raynaud's phenomenon, particularly in elderly patients with comorbidities. The rapid progression and refractory nature of the condition highlight the need for early recognition and aggressive management.
雷诺现象（RP）的特征是小血管的发作性血管痉挛，主要影响手指和脚趾。治疗方法包括生活方式调整、药物治疗，严重情况下还包括手术干预。在此，我们报告一例80岁男性患者，有高血压、血脂异常、肥胖和房颤病史，在轻度新冠病毒感染（无呼吸困难或低氧血症）后因双手手指水肿、发绀和剧痛就诊于急诊科。尽管生命体征稳定且体格检查无其他异常，但实验室检查显示白细胞增多、炎症标志物升高及局部感染迹象。因此，他被收入病房，接受抗生素（阿莫西林/克拉维酸）、用于血管舒张的硝苯地平以及用于控制疼痛的阿片类药物治疗。然而，他的病情恶化，出现进行性坏死，需要将治疗升级为伊洛前列素输注和波生坦治疗。右手无改善，计划围绕伤口护理进行手术干预，目标是使手指干性坏疽并随后截肢。左手在持续用药后逐渐好转。住院期间，血清学检测和甲襞毛细血管镜检查未发现任何继发性病因，如结缔组织病。影像学检查排除了潜在的肿瘤和血栓形成。该患者被诊断为严重雷诺现象，可能由近期的新冠病毒感染引发，这一现象已在病例报告中有所描述。该病例强调了新冠病毒作为严重雷诺现象促发因素的潜在影响，尤其是在患有合并症的老年患者中。该病的快速进展和难治性凸显了早期识别和积极治疗的必要性。
