PARANEOPLASTIC RAYNAUD’S PHENOMENON WITH DIGITAL NECROSIS

Morrone A., Calcaterra R., Mussi A., Franco G., Carducci M.

21° WORLD CONGRESS OF DERMATOLOGY
Buenos Aires, September 30 – October 5 2007

Background
Paraneoplastic Raynaud’s phenomenon associated with digital necrosis is a rare condition of ischaemic origin. It represents an unusual manifestation of internal malignancies such as neoplasm of gastrointestinal tract, lung and breast.
Methods
We analysed the cases of paraneoplastic Raynaud’s phenomenon with digital necrosis afferent to San Gallicano Dermatological Institute
Result
We report a case of paraneoplastic Raynaud’s phenomenon and digital necrosis in a patient affected by a metastasising squamous cell carcinoma of the penis associated with antiphospholipidic antibodies and hyperhomocysteinaemia.
Conclusion
Clinically, paraneoplastic digital necrosis is characterized by ischaemic lesions from splinter haemorrhages and pulp atrophy to digital gangrene, usually preceded by Raynaud’s phenomenon with a typical fulminant and rapid course. It may represent the only manifestation of an underlying malignancy; so malignant disorder should be carefully searched in patients with an abrupt onset of Raynaud’s phenomenon and digital necrosis, even in absence of abnormal laboratory findings and negative past medical history of thromboembolic disease or connective tissue disorders.
The most often associated neoplasms are lung, breast and gastrointestinal cancers; but this condition has been also reported associated with ovarian and uterine carcinomas, renal adenocarcinoma, multiple myeloma, leukaemia and Hodgkin’s lymphoma. On the contrary, the association of digital necrosis and squamous cell carcinoma of the penis has never been reported, so far. Moreover, we report for the first time an alteration of the thrombophilic status that may be implicated in the pathogenesis of digital necrosis.
1. Chow SF, McKenna CH. Ovarian cancer and gangrene of the digits: case report and review of the literature. Mayo Clin Proc 1996;71(3):253-258.
2. Brooks PM. Rheumatic manifestation of neoplasia. Curr Opin Rheumatol 2002;4:90-93.