A Case of Critical Digit Ischemia in a Patient With Suspected Seronegative Scleroderma Diagnosed via Nailfold Capillaroscopy.

Abstract

Systemic sclerosis (scleroderma) can manifest with advanced symptoms of ischemic vasculopathy, including digital ulcer development. These ulcerations can be disabling and detrimental to a patient's quality of life, so prompt diagnosis, differentiation from other vascular etiologies, and treatment are important to help salvage this tissue. However, diagnosis of scleroderma can be challenging in the setting of seronegative disease. Nailfold capillaroscopy is a vital tool that can assist with diagnosis in seronegative cases. Scleroderma pattern findings on nailfold capillaroscopy include dilated or giant capillaries, capillary hemorrhages, and dropouts. Pharmacologic and surgical modalities can effectively treat vascular complications from scleroderma. Vasodilation therapy with prostacyclin analogs, calcium channel blockers, or angiotensin II receptor blockers can improve ischemic tissue perfusion. Surgical sympathectomy should be offered to treat ulcerative tissue and improve related pain control. We present a case of seronegative scleroderma in a patient with digital ischemic ulcerations that was expediently diagnosed and treated with assistance of nailfold capillaroscopy.