Digital ischemic in patient with systemic sclerosis

A 49-year-old man was admitted to the hospital due to pain in the fingers for one year before admission. He also had shortness of breath, precipitating with activity and getting better when taking a rest. Patient fulfilled the American College of Rheumatology classification criteria for systemic sclerosis. He also had systemic involvement including interstitial lung disease and Raynaud’s phenomenon with digital ischemia. We had to uplift the challenging issue in management of digital ischemia. We provided the initial treatment using standard treatment and heparinization. Necrotic lesion was improved but he was readmitted for worsening ischemic stroke after discharged with warfarin, and thereafter, amputation was performed. In conclusion, we reveal that the diagnosis of systemic sclerosis and identification of its complication should involve a comprehensive investigation, and the management of digital ischemia should prioritize non-invasive method, as currently no established recommendation regarding management of digital ulcers in Raynaud’s.