Capillaroscopic pattern in paraneoplastic Raynaud's phenomenon.
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.
Department for Propaedeutics of Internal Medicine, Clinic of Rheumatology, Medical University, Plovdiv, Bulgaria. sevdalina_n@abv.bg
S
S
Lambova
U
U
Müller-Ladner
D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000473:pathology* / Q000503:physiopathology; D011928:Raynaud Disease / Q000473:pathology* / Q000503:physiopathology
Arthritis Rheum. 1980 Feb;23(2):183-9
7362667
Drugs Aging. 1999 Sep;15(3):183-95
10503811
Curr Opin Rheumatol. 2006 Mar;18(2):129-34
16462517
Semin Arthritis Rheum. 1995 Feb;24(4):231-41
7740303
Arthritis Rheum. 2003 Nov;48(11):3023-30
14613262
J Rheumatol. 2000 Jan;27(1):155-60
10648032
Int J Colorectal Dis. 1996;11(4):196-7
8876279
Semin Arthritis Rheum. 1999 Aug;29(1):43-55
10468414
Pol Arch Med Wewn. 2008 Mar;118(3):119-26
18476458