Digital Gangrene Associated with Anticentromere Antibodies
A 75 year old lady presented with sudden onset of severe pain and blackish discoloration of the index finger of her left hand. She did not give any history suggestive of Raynaud's phenomenon, or arthritis. In fact she did not have any significant illness in the past, including diabetes, hypertension, or coronary artery disease. She did not have any addictions and she was not on any regular medications. On examination, there was digital necrosis of the distal finger with an adjacent area of pale swollen tissue with ulceration. No sclerodactyly was evident. There was no evidence of peripheral vascular disease. All her peripheral pulses were felt equally on both sides. There was no audible bruit. Her BP was 130/80 mm of Hg. All system examinations were within normal limits. Investigations revealed normal hemoglobin, total leukocyte count, platelet count and ESR. Her blood sugar, renal and liver function tests were within normal limits. ECG, X-ray chest and USG abdomen were also normal. Her ANA titre was elevated and ANA profile showed a strongly positive anticentromere antibody. Anti-double stranded DNA, anti-Sjogren's Syndrome A, anti-Sjogren's Syndrome B and anti-ribonucleoprotein antibodies (anti-SSA, anti-SSB, anti-RNP), anti-Sm, anti-Scl-70 were negative.