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Successful outcome in a case of critical digital ischemia. Case report and literature analysis
Critical digital ischemia (CDI) remains a distinct, serious complication of peripheral vasculopathy in systemic sclerosis, macrovascular as well as microvascular disease, abnormal vascular remodeling, vasoconstriction-vasodilation imbalance and fibrosis being key underlying factors. Successful short- as well as long-term outcomes may arise from early diagnosis, broad assessment and prompt therapeutic intervention. However, current treatment options are far from ideal, indicating the need for a complex approach focused on pathobiologic issues. We report the case of a middle age postmenopausal woman with a recent onset of CDI and subsequent gangrene, evolving in a very early PM-Scl positive systemic sclerosis. Dramatic improvement with complete resolution of CDI as well as healing of digital gangrene with minimal tissue loss was rapidly achieved under vasodilating therapy, after two cycles of intravenous prostanoids.
Keywords: critical digital ischemia, systemic sclerosis, anti-PM-Scl autoantibodies, prostanoids
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