Abstract
The capillaroscopic pattern in paraneoplastic Raynaud’s phenomenon (RP) has not been investigated systematically and is not well-defined. Here, we present three case reports of patients with paraneoplastic rheumatic conditions, manifested with severe secondary RP with emphasis upon capillaroscopic findings. The first patient is a 58-year-old male with known psoriasis and psoriatic arthritis, severe RP and scleroderma-like syndrome, resulting in a paraneoplastic syndrome in the context of a lung cancer. At capillaroscopic examination classic “scleroderma” pattern, an “early” type was found. The second patient is a 48-year-old woman with an abrupt onset of paraneoplastic dermatomyositis, severe RP, and a lung cancer. The capillaroscopic examination revealed frequent dilated and giant capillaries, hemorrhages and severe microvascular disarrangement—the so-called “scleroderma-like” pattern typical of the idiopathic forms of the disease. The third patient is a 56-year-old woman with paraneoplastic dermatomyositis, secondary RP, and thyroid cancer. The capillaroscopic examination showed dilated and giant capillaries, elongated capillaries, decreased mean capillary density with avascular areas, severe disarrangement, single hemorrhages, and clear evidence of neoangiogenesis. These capillaroscopic features characteristic of the “scleroderma-like” pattern are indistinguishable from those in idiopathic dermatomyositis like in the second case. Taken together, the cases illustrate the problem that capillaroscopic patterns in paraneoplastic RP in the context of scleroderma-like syndrome and dermatomyositis appear to be indistinguishable from the microvascular changes in the respective idiopathic rheumatic diseases.
References
Bernatsky S, Ramsey-Goldman R, Clarke A (2006) Malignancy and autoimmunity. Curr Opin Rheumatol 18:129–134
Naschitz JE, Rosner I, Rozenbaum M et al (1999) Rheumatic syndromes: clues to occult neoplasia. Semin Arthritis Rheum 29(1):43–55
Nashitz JE, Rosner I, Rozenbaum M et al (1995) Cancer-associated rheumatic disorders: clues to occult neoplasia. Semin Arthritis Rheum 24(4):231–241
Ciołkiewicz M, Domysławska I, Ciołkiewicz A et al (2008) Coexistence of systemic sclerosis, scleroderma-like syndromes and neoplastic diseases. Pol Arch Med Wewn 118(3):119–126
Ling SM, Wigley FM (1999) Raynaud’s phenomenon in older adults. Diagnostic considerations and management. Drugs Aging 15(3):183–195
Paw P, Dharan SM, Sackier JM (1996) Digital ischemia and occult malignancy. Int J Colorectal Dis 11:196–197
Maricq HR, LeRoy EC, D’Angelo WA et al (1980) Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 23(2):183–189
Cutolo M, Grassi W, Matucci Cerinic M (2003) Raynaud’s phenomenon and the role of capillaroscopy. Arthritis Rheum 48(11):3023–3030
Cutolo M, Sulli A, Pizzorni C, Accardo S (2000) Nailfold videocapillaroscopy assessment of micro vascular damage in systemic sclerosis. J Rheumatol 27:155–160
Acknowledgments
The study is supported by EULAR stiepend for scientific project for 2009 of Dr. S. Lambova.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lambova, S., Müller-Ladner, U. Capillaroscopic pattern in paraneoplastic Raynaud’s phenomenon. Rheumatol Int 33, 1597–1599 (2013). https://doi.org/10.1007/s00296-010-1715-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-010-1715-8