Digital necrosis in a patient with atherosclerosis - Also a paraneoplasia? [Fingernekrose bei einem Patienten mit Atherosklerose - auch paraneoplastisch bedingt?]

摘要

History and admission findings: A 59-year-old man was admitted with an acral necrosis of the left 3 rd finger, which had developed during several weeks. Furthermore, the patient complained of diarrhoea. Investigations: Acral light plethysmography showed critical ischemia of digitus II and V, and impaired distal perfusion of digitus I and IV. Duplex sonography revealed atherosclerotic plaques in the supraaortal vessels with stenosis of the left axillary artery which was confirmed by ultrasound. However, no differences in the pressure of ulnar and radial arteries existed. Colonoscopy and abdominal computed tomography revealed two colon neoplasms, including hepatic metastasis. Treatment and course: The stenosis of the left axillary artery was considered as the source of distal embolisation. However, after morphologically successful angioplasty distal necrosis worsened with involvement of additional fingers. Later in the course, diagnostic work-up of diarrhoa established the diagnosis of metastatic colorectal cancer. Finally, the patient died because of intercurrent pneumonia. Conclusion: Spontaneous acral necrosis may develop due to embolisation or local thrombotic vessel occlusion. Progression despite successful treatment of a potential source of embolism points to a significant coagulopathy, as in metastatic cancer.