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December 6, 1976

Digital Gangrene

JAMA. 1976;236(23):2656. doi:10.1001/jama.1976.03270240052031

The development of tissue necrosis of the tips of fingers and toes suggests Raynaud disease or Raynaud phenomenon. The latter is sometimes the signal manifestation in varied diseases, including scleroderma, pneumatic hammer disease, scalenus anticus syndrome, cervical rib, shoulder-hand syndrome (reflex sympathetic dystrophy), peripheral arterial disease (arteriosclerosis, thromboangiitis obliterans), drug poisoning (ergot, methysergide), and several hematologic disorders in which exposure to cold causes sludging of blood. Three recent reports in publications of the American Medical Association present other causes for consideration.

In the current issue of Archives of Internal Medicine (136:1273-1280, 1976), Gipstein and his colleagues describe 11 patients with chronic renal insufficiency owing to various causes, who, while under treatment by long-term hemodialysis (five cases) or by functioning homotransplants (six cases), developed livedo reticularis and painful ischemic ulcers of the fingers or toes or both. In some cases, cutaneous necrosis also appeared in other areas of the lower extremities.