A 15-year-old man presents to the clinic accompanied by his mother for evaluation of “red hands.”
He earned money last winter clearing sidewalks of snow and plans to do so again in the upcoming
weeks. He reports developing red discoloration of his hands after returning home from the cold. The
discoloration persisted for a few minutes until his hands were rewarmed. He denies weakness,
paresthesia, pain, or skin lesions. He is otherwise healthy. At the time of consultation, inspection of
his hands is unrevealing. Radial and ulnar pulses are 2+/2 bilaterally. The Allen test and reverse
Allen test reveal return of color to the hands in 7 seconds bilaterally. His mother reports that she and
her mother both have Raynaud phenomenon. The patient’s mother expresses concern that her son may
have systemic lupus and she requests further testing.
What is the most likely diagnosis?
a. Raynaud disease
b. Raynaud phenomenon
c. Normal physiologic cold response
d. Acrocyanosis
e. Thermal injury
Answer - c. Normal physiologic cold response.
This patient is exhibiting a normal response to prolonged
exposure to cold. The diagnosis of Raynaud phenomenon is clinical and includes the presence of
pallor or acrocyanosis and pain with cold exposure. Redness of the hands with warming after
prolonged cold exposure, without concomitant pain, may be a normal response in a healthy young
individual. He should be counseled to wear gloves and report any change in his symptoms, as his
family history does predispose him to development of Raynaud phenomenon.
He earned money last winter clearing sidewalks of snow and plans to do so again in the upcoming
weeks. He reports developing red discoloration of his hands after returning home from the cold. The
discoloration persisted for a few minutes until his hands were rewarmed. He denies weakness,
paresthesia, pain, or skin lesions. He is otherwise healthy. At the time of consultation, inspection of
his hands is unrevealing. Radial and ulnar pulses are 2+/2 bilaterally. The Allen test and reverse
Allen test reveal return of color to the hands in 7 seconds bilaterally. His mother reports that she and
her mother both have Raynaud phenomenon. The patient’s mother expresses concern that her son may
have systemic lupus and she requests further testing.
What is the most likely diagnosis?
a. Raynaud disease
b. Raynaud phenomenon
c. Normal physiologic cold response
d. Acrocyanosis
e. Thermal injury
Answer - c. Normal physiologic cold response.
This patient is exhibiting a normal response to prolonged
exposure to cold. The diagnosis of Raynaud phenomenon is clinical and includes the presence of
pallor or acrocyanosis and pain with cold exposure. Redness of the hands with warming after
prolonged cold exposure, without concomitant pain, may be a normal response in a healthy young
individual. He should be counseled to wear gloves and report any change in his symptoms, as his
family history does predispose him to development of Raynaud phenomenon.
No comments:
Post a Comment