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Treatment of gangrenous digit-threatening paraneoplastic acrocyanosis with vasodilator therapy
  1. Kathryn Biddle,
  2. Joseph Nathan and
  3. Virinderjit Sandhu
  1. Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Kathryn Biddle; kathryn.biddle{at}


A man in his 70s, with a recent diagnosis of transitional cell carcinoma of the bladder, reported a 2-month history of discolouration, pain and paraesthesia affecting his fingers. Clinical assessment noted peripheral acrocyanosis with areas of digital ulceration and gangrene. Following further work-up to evaluate potential causes, he was diagnosed with paraneoplastic acrocyanosis. He proceeded to undergo robotic cystoprostatectomy and received adjuvant chemotherapy for the management of his cancer. In parallel to the chemotherapy, vasodilatory therapy was administered as two courses of intravenous synthetic prostacyclin analogue iloprost along with sildenafil. This resulted in a significant improvement in digital pain and gangrene with healing of ulceration.

  • Oncology
  • Rheumatology

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  • Contributors JN and KB contributed equally to the manuscript. Both authors reviewed the patient and wrote the case report. VS supervised the writing of the case report and critically appraised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.