title: Difficulties in diagnosis and treatment of severe secondary Raynaud's phenomenon in a Cameroonian woman: a case report.
abstract: BACKGROUND
  Raynaud's phenomenon is a microvascular disorder that results in exaggerated vasoconstriction over vasodilatation secondary to an alteration in autonomic control. Though benign, it can result in severe ulceration and ultimately gangrene associated with disfiguration and permanent deformity. We present a case of severe secondary Raynaud's phenomenon in a black-African patient from a resource-limited setting, with focus on the difficulties encountered in the diagnosis and treatment.
  
  
  METHODS
  A 43-year-old female Cameroonian farmer with a 7-year history of episodic paresthesia in her fingers and toes (when exposed to cold) presented to our emergency department with severe pain, ulceration, and "darkening" of her fingertips over a period of 2 days. An examination revealed bilateral ulceration and dry gangrene of her fingers and toes, based on which a diagnosis of secondary Raynaud's phenomenon due to a connective tissue disease was proposed. Results of paraclinical investigations were normal. Lifestyle modification along with a calcium channel blocker and phosphodiesterase type 5 inhibitor provided significant relief.
  
  
  CONCLUSIONS
  An early diagnosis and knowledge on appropriate treatment of Raynaud's phenomenon is of vital importance to prevent permanent tissue damage and disability. Relying on biphasic color change for the diagnosis of Raynaud's phenomenon in black Africans can be potentially misleading.
authors.affiliation: Ibal Sub-Divisional Hospital, Oku, North West Region, Cameroon. nvagbor@gmail.com.
authors.forename: Valirie Ndip
authors.initials: VN
authors.lastname: Agbor
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxfordshire, UK.
authors.forename: Tsi
authors.initials: T
authors.lastname: Njim
authors.affiliation: Clinical Research Education, Networking and Consultancy (CRENC), Douala, Littoral, Cameroon.|School of Public Health, Faculty of Medicine & Biomedical Sciences, University of Queensland, Brisbane, Australia.
authors.forename: Leopold Ndemnge
authors.initials: LN
authors.lastname: Aminde
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044383:Black People; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003023:Cloxacillin / Q000627:therapeutic use; D003240:Connective Tissue Diseases / Q000150:complications* / Q000473:pathology; D037001:Directive Counseling; D005260:Female; D005385:Fingers / Q000473:pathology*; D005734:Gangrene; D006801:Humans; D008019:Life Style; D008833:Microcirculation / Q000187:drug effects*; D009543:Nifedipine / Q000627:therapeutic use; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D011928:Raynaud Disease / Q000150:complications / Q000473:pathology* / Q000628:therapy; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate / Q000627:therapeutic use; D014034:Toes / Q000473:pathology*; D014147:Tramadol / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents; D002121:Calcium Channel Blockers; D058986:Phosphodiesterase 5 Inhibitors; D014147:Tramadol; D000068677:Sildenafil Citrate; D009543:Nifedipine; D003023:Cloxacillin
keywords: Cameroon; Connective tissue disease; Secondary Raynaud’s phenomenon