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Case 379


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Patient A.C.F, female, 28 years old, resident of Belo Horizonte, was attended on the Emergency Unit of Hospital das Clínicas - UFMG reporting cyanosis followed by paleness in her fingers during exposure to cold or emotional stress. On physical examination, there’s pallor in almost the entire length of the distal phalanges of fingers II to V, without other findings.

Based on the images and the clinical history, which of the following diagnosis is the most likely?

a) Pernio (cold lesion)


b) Raynaud’s phenomenon


c) Upper limb thrombosis


d) Thromboangiitis obliterans (Buerger disease)


Image analysis


Image 1 - Analysis: Photo of the patient’s left hand revealing pallor in almost all extension of the distal phalanges of fingers II to V.



-       Raynaud's phenomenon is more common in women affects women five times more than men. The age range varies from 20 to 40 years;

-       It can be primary or secondary to diseases that cause vasospasm. The primary form is more common;

-       It’s characterized by episodic digital ischemia, manifesting clinically with pallor and cyanosis followed by redness in the fingers or toes. It is usually precipitated by cold or emotional factors;

-       The secondary form is mainly associated to scleroderma, SEL, dermatomyositis, polymyositis and rheumatoid arthritis;

-       Manifestations are usually mild and can be avoided by protection and warming of the fingers. Pharmacological and surgical treatment are reserved for severe and refractory cases with potential necrotic ischemic injury.






André Luiz Marzano de Assis, 5th year medical student at Universidade Federal de Minas Gerais.

E-mail: andre_marzano[at]


Prof. Débora Cerqueira Calderaro, adjunct professor of the Department of Locomotor System and rheumatologist doctor at Hospital das Clínicas da UFMG.

E-mail: dccalderaro[at]


Ana Luísa Melgaço, Larissa Rezende, Mateus Nardelli, Prof. Júlio Guerra.

Translated by

Leandra Prates Diniz, 5th year medical school at Universidade Federal de Minas Gerais

E-mail: leandraprates[at]

Test question

(SANTA CASA-GO) Which of the following affirmatives represents the correct epidemiology of Raynaud's Phenomenon?

a) Raynaud's phenomenon is associated with connective tissue disease in about 50% of cases.


b) Raynaud's phenomenon is not commonly associated with manual labor by men.


c) Emotional stress is a common precipitating factor for Raynaud's phenomenon in women.


d) Raynaud's phenomenon is not caused by any associated disease in 10-20% of cases.





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