Abstract
A 58-year-old female was admitted to our hospital for fever, polyarthritis, pleuritis and pericarditis. She had noticed Raynaud's phenomenon at about age 30. Two years prior to admission, small painful ulcers were noted at the tips of the index fingers of both hands. Chronic hemodialysis was initiated by placement of a Brescia-Cimino arteriovenous fistula in her left forearm at another hospital 10 months before admission to our hospital. When she was first seen by us, sclerodactylia, digital bone absorption and pulmonary fibrosis were observed and a diagnosis of progressive systemic sclerosis (PSS) was made. The patient was treated with remarkable effect with prednisolone (30mg/day) and her symptoms gradually disappered. However, 3 months afer admission, painful digital ulcer of the left third finger apex appeared. Three months later, the same ishemic change also developed on her left small finger. After starting each hemodialysis therapy, pain, pallor and coldness of the left hand worsened markedly. These ischemic symptoms were considered to be the result of radial steal syndrome. This case indicates the importance of considering the type and site of arteriovenous fistula in hemodialysis patients with PSS.
