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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

A Journal on Internal Medicine and Pharmacology


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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 May;172(5):379-85

language: English

Digital ulcer, Raynaud phenomenon and osteomyelitis of the fifth finger in patient with systemic sclerosis. Personal experience

Cremona F. 1, Maiorana A. 1, Meli F. 2, Farinella D. 3, Agnello G. 1

1 Department of General Surgery and Metabolic Diseases, Paolo Giaccone General Hospital, Palermo, Italy;
2 Department of Angiology, Paolo Giaccone General Hospital, Palermo, Italy;
3 Department of Sciences for Health Promotion,, “Hygiene and Preventive Medicine”, Paolo Giaccone General Hospital, Palermo, Italy


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The authors report a case of recent observation of digital ulcer associated with vascular disease (Raynaud phenomenon) and osteomyelitis of the right fifth finger, in patient with systemic sclerosis (SSc). Raynaud phenomenon (RP) is an universal manifestation of SSc (95% of these patients are affected); in 30% of the patients resulted in digital ulcers (DUs). The authors emphasize the importance of early clinical and surgical management, because the effect on function (functio laesa) and quality of life of the SSc-DU is significant, and they are associated with pain, disability and disfigurement. In our case history, remarkable remission of digital ulcer (of the right fifth finger) was achieved with long-term administration of mepivacaine into the lesion, its toilette and addition of antibiotic ointment. Subsequently, the patient decided to perform a local sperimental treatment with bosentan, hesitated with good results, both locals that systemic. Despite a considerable clinical outcome, we do not exclude in the future to implement a surgical treatment to correct alterations no-reversible by clinical treatment with bosentan. Our patient has a good response to clinical treatment; currently the clinical of patient is in a stable phase. At last she has resolution specially of pain symptom, caused in part by persistent osteomyelitis, implementing her quality of life. The object of this paper is to discuss about definitions, origin, pathogenesis, diagnostic standards, clinical classification and therapy of secondary digital ulcer in SSc. The authors believe in the surgical treatment as only procedure to the cure of the patient, when the DUs are not clinically more tractable.

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