Three Cases of Digital Ulcer Accompanied by Collagen Diseases

Abstract

We report here 3 cases of digital ulcers in women accompanied by collagen diseases. The first case consisted of a 76-year-old woman presented with skin ulcer on her right fifth toe. She had been treated for rheumatoid arthritis but the disease activity was low, according to the level of CRP and erythrocyte sedimentation rate. Angiography of the right foot revealed peripheral arterial occlusion of right tibia and fibula, and low bloodstream in the peripheral artery of dorsum and sole of foot. Amputation of her fifth toe was performed at the metatarsophalangeal joint, but subsequently, she repeatedly developed new ulcers around her toenail. Case 2 was a 64-year-old woman who presented with skin ulcer on her right first toe. She had been diagnosed with systemic sclerosis and interstitial pneumonia, but no therapy was needed. Angiography of the right foot revealed occlusion of the periphery of the anterior and posterior tibial arteries. Amputation of her first toe was performed at the metatarsophalangeal joint following right posterior tibial artery bypass graft. Case 3 was a 40-year-old woman who presented with gangrene on her right second fingertip. She had been treated with oral prednisolone (5 mg daily) for mixed connective tissue disease. Angiography of the hand revealed occlusion of the right and left ulnar artery at the wrist. Further, at the periphery of her first, second and third fingers, the proper palmer digital arteies on both sides were occluded. The progression of fingertip gangrene was stopped by increasing the dose of oral prednisolone (up to 20 mg daily) and administration of warfarin potassium. In all 3 cases, high titers of anti-centromere antibodies were found. The evaluation of the activity of systemic rheumatic disease, especially in cases with high titers of anti-centromere antibodies, is very important for the treatment of digital ulcers.