Massive Multi-Fingered Gangrene in a Black African Patient with Systemic Scleroderma: A Rare and Disabling Complication
DOI:
https://doi.org/10.5281/hra.v2i1.5171Abstract
ABSTRACT
This article presents a rare case of severe pluridigital digital necrosis in a Black African patient with systemic sclerosis (SSc). The 29-year-old woman, irregularly monitored for two years, was admitted with dyspnea and necrosis of fingers and toes. The necrotic lesions involved multiple digits, affecting proximal phalangeal joints. Inflammatory markers were elevated, and echocardiography revealed intra-left ventricular thrombus and pulmonary arterial hypertension. The diagnosis indicated a systemic sclerosis flare with vascular and cardiac involvement. Treatment included corticosteroids, nifedipine, rivaroxaban, and antibiotics. Surgical intervention amputated necrotic digits, and the background treatment was adjusted. Our study highlights the rarity and severity of pluridigital digital necrosis in SSc, emphasizing the need for meticulous medical and surgical management. After four months, stump healing was observed.
RÉSUMÉ
Cet article présente un cas rare de nécrose digitale pluridigitale sévère chez une patiente africaine noire atteinte de sclérodermie systémique (SSc). Cette femme de 29 ans, suivie de manière irrégulière pendant deux ans, a été admise pour dyspnée et nécrose des doigts et des orteils. Les lésions nécrotiques ont touché plusieurs doigts, affectant les articulations phalangiennes proximales. Les marqueurs inflammatoires étaient élevés, et l'échocardiographie a révélé la présence d'un thrombus intra -ventriculaire gauche et une hypertension artérielle pulmonaire (HTAP). Le diagnostic a indiqué une poussée de sclérodermie systémique avec atteinte vasculaire et cardiaque. Le traitement comprenait des corticostéroïdes, de la nifédipine, du rivaroxaban et des antibiotiques. Une intervention chirurgicale a amputé les doigts nécrotiques, et le traitement de fond a été ajusté. L'étude met en lumière la rareté et la gravité de la nécrose digitale pluridigitale dans la SSc, soulignant la nécessité d'une prise en charge médicale et chirurgicale méticuleuse. Après quatre mois, une cicatrisation des moignons a été observée.
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