Nearly half of patients with systemic sclerosis (SSc) experience a digital ulcer, and many of these ulcers may progress to digital gangrene. Gangrene can stem from inadequate healing of digital ulcers or complications of comorbidities along with elevated C-reactive protein (CRP) levels.
A 49-year-old woman diagnosed with systemic lupus erythematosus (SLE) and an overlap with SSc since 2006 presented in December 2010 with a 1-day history of acute pain and discoloration of all her digits (Figure 1).
Her connective tissue disease course was characterized by sclerodactyly, gastrointestinal reflux, inflammatory arthritis, serositis, oral ulcers, Raynaud’s phenomenon (RP), positive antinuclear antibody with titer 1:640 in a speckled pattern, rheumatoid factor, anti-Sm, and anti-RNP antibodies. She was treated since 2008 with stable doses of methotrexate and leflunomide. She was not known to have any risk factors for atherosclerosis such as diabetes mellitus, hypertension, or dyslipidemia, and she did …