Gastric antral vascular ectasia unmasked by alprostadil for digital ulceration in scleroderma.

摘要

We describe a 54-year-old woman with systemic sclerosis (scleroderma, SSc) of the limited subtype. Diagnosis in 1994 was based on tightness of the skin distal to the metacarpophalangeal joints, calcinosis, telangiectasia, esophageal dysmotility, and severe Raynaud's phenomenon (RP) complicated by recurrent digital ulcers, gangrene and autoamputation. Her serol-ogy is significant for positive antinuclear antibody, and anticentromere antibody. During her disease course, she received different regimens of vasodilators including nifedipine, losartan, and topical nitroglycerin in addition to aspirin, with inadequate response. In May 2010 she presented with a refractory ulcer in the right third digit. Despite increase in her vasodilator therapy and addition of pentoxifylline, it progressed to diffuse ulceration of the digit, extending proximal to the distal interphalageal joint. Magnetic resonance imaging revealed no evidence of osteomyelitis. It was decided to admit her to hospital for intravenous (IV) prostaglandin.