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Painful, Patchy Pallor And Hyperemia In The Feet Of A Completive 16 Year-old Swimmer - Page #4
 

Working Diagnosis:
Atypical primary vasospasm

Treatment:
Given lack of efficacy from nifedipine, recommendations to primary care provider were given for initiation of alpha blocker (low dose doxazosin or prazosin) vs sildenafil or endothelin antagonist. <br> <br>Patient is currently considering medication options and activity modification for symptom management.

Outcome:
Patient is cleared to return to swimming, modifying her activity based on symptoms.

Author's Comments:
Primary vasospasm can be thought of as an exaggerated response to the body&#039;s normal vasospasm in cold temperatures. This may also be triggered by emotional stress. <br>May affect 3-5% of the global population with a shift in higher prevalence in colder climates, and may be familial. Females are disproportionately affected greater than males, 7:1. <br>&quot;Triphasic&quot; color pattern changes of pallor, cyanosis and rubor are characteristic for vasospasm. <br>Primary vasospasm must be differentiated from secondary vasospasm, which may have additional complications. <br>In our patient, this phonomania was not entirely temperature dependent. There were no identified factors to attribute this vasospastic process to. Our patient&#039;s vasospastic process was discoordinated, involving patchy areas in both feet. Typically primary vasospasm is thought of as a symmetric process. Generally this affects the hands primarily; however in our athlete the feet were most affected.

Editor's Comments:
Interesting case to be sure, with impressive visuals.

References:
1- Maverakis E et. al. International consensus criteria for the diagnosis of Raynaud&#039;s phenomenon. J Autoimmun. 2014 Feb-Mar;48-49:60-5. PMID: 24491823; PubMed Central PMCID: PMC4018202. <br>2- Linnemann B, Erbe M. Raynaud&#039;s phenomenon - assessment and differential diagnoses. Vasa. 2015 May;44(3):166-77. doi: 10.1024/0301-1526/a000426. Review. PubMed PMID: 26098320.

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