A 60-year-old male presented to the Department of Medicine of MKCG Medical College with complaints of sudden onset, severe localized pain over the distal part of fingers and toes of both the hands, feet and tip of the nose. The hands were affected more than the feet, right hand more than the left, 2 nd and 3 rd digits more than the rest of the fingers [Table/ Fig-1]. The pain gradually increased in intensity over the last two days, did not subside by analgesics and was associated with sensation of pins and needles over the affected parts. He also complained of joint pain over bilateral knee, ankle, distal interphalangeal and metacarpophalangeal joints of hand.There was no history of fever, intake of ergotamine drugs or beta blockers, any insect bite, or living at high altitude at any point of time. There was no history of diabetes, hypertension, peripheral vascular diseases, respiratory ailment, rheumatoid arthritis, Raynaud's phenomenon or any other connective tissue disorders. He was not a smoker.General physical examination was unremarkable. Pulse was 84/ minute, regular and all peripheral pulses were well felt. Blood pressure was 130/80 mm Hg. Systemic examination was also normal except for decreased touch, pain and temperature sensation over the tips of fingers and toes. The affected parts revealed a cold, cyanosed distal phalanx of both hands and feet. Allen's and Adson's tests were negative.A provisional diagnosis of symmetrical peripheral gangrene was made.Complete haemogram along with peripheral smear revealed dimorphic anemia [
ABSTRACTCryoglobulins are monoclonal or polyclonal immunoglobulins that undergo reversible precipitation at low temperatures. Cryoglobulinemia is associated with HCV infection in more than 90% cases, the remaining 10% being called as Essential Cryoglobulinemia which is generally associated with a severe course and suboptimal response to conventional therapies. As the digital vessels are more prone to colder temperatures, hyperviscosity in those vessels can initiate local thrombosis and may manifest as ischemic ulceration and gangrene. We report here a very unusual case of HCV negative cryoglobulinemic vasculitis presenting as symmetrical peripheral gangrene of fingers and toes.Keywords: Acronecrosis, Essential mixed cryoglobulinemia, Symmetrical digital gangrene, Vasculitis.normal. Serum antibodies against malarial parasite, HIV, Hepatitis B and Hepatitis C virus were absent. C-Reactive Protein (CRP) and Rheumatoid factor were positive.Antinuclear antibody (ANA) came out to be positive (47.2)(Positive = >23 IU/ml). Anti ds-DNA, anti Smooth muscle Ab, anti Scl-70 were negative. Complement studies revealed a normal C3 levels (110 mg/dL) (Reference range: 88-252 mg/dl) and low C4 levels (8 mg/dL) (Reference range: 12-72 mg/dl). Bone marrow aspiration study revealed hypercellular marrow with no evidence of metastatic deposits or leukemia. Reactive plasma cells were increased in number.Serum was then evaluated for the presence of cryoglobulins (qualitative) which revealed presence o...
