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An interesting case-based review
Acute peripheral/cutaneous ischemic syndrome (APCIS), what rheumatologist should know?
APCIS is a clinical syndrome, representing the clinical appereance of skin and/or limb severe ischemia due to several etiologies.
https://pubmed.ncbi.nlm.nih.gov/33315786/
Acute peripheral/cutaneous ischemic syndrome (APCIS), what rheumatologist should know?APCIS is a clinical syndrome, representing the clinical appereance of skin and/or limb severe ischemia due to several etiologies.
https://pubmed.ncbi.nlm.nih.gov/33315786/
Vessel wall abnormalities: atherosclerosis, calciphylaxis, vasculitis.Embolism: cardiac, aneurysms, cholesterol emboli.Local thrombosis: hypercoagulable states.Dysproteinemias.Venous limb gangrene: extensive venous thrombosis + compromise in arterial flow.
Clinical conditions relevant to the rheumatologist:
Antiphospholipid syndrome.
Vasculitis.
Autoimmune diseases (SLE).
Cryoproteinemias (cryoglobulinemia).
Others: DADA2...
Antiphospholipid syndrome.Vasculitis.Autoimmune diseases (SLE).Cryoproteinemias (cryoglobulinemia).Others: DADA2...
Diagnosis:
Rule out infections, emboli, atherothrombotic disorders!
Blood tests, blood smear, blood cultures, coagulation panel, autoantibodies, cryoglobulins, search for monoclonal proteins...
Echocardiogram, arterial/venous ultrasound, EKG.
Consider tissue biopsy.
Rule out infections, emboli, atherothrombotic disorders! Blood tests, blood smear, blood cultures, coagulation panel, autoantibodies, cryoglobulins, search for monoclonal proteins...Echocardiogram, arterial/venous ultrasound, EKG.Consider tissue biopsy.
After initial workout, in patients without evident infection or atherothrombotic/embolic disorders, suggesting an autoimmune pathology (APS, vasculitis...):
Anticoagulation + low-dose aspirin + high dose steroids (not in SSc).
Vasodilators ( prostacyclins...).
Anticoagulation + low-dose aspirin + high dose steroids (not in SSc). Vasodilators ( prostacyclins...).
