Association between Digital Ischaemia and Malignant Disease

Abstract

Six cases are described suggesting an association between digital ischaemia and malignant disease. They were a group of middle-aged women who either presented with atypical Raynaud's phenomenon or in whom this was a prominent feature. The symptoms were of sudden onset, bilateral in five cases, and in four rapidly progressed to gangrene. None of the commonly accepted causes of digital ischaemia was present. On investigation three patients were found to have a primary carcinoma of the maxillary antrum, kidney, and ovary, respectively; one patient had primary carcinomata of both the colon and corpus uteri, and in another the origin was not established but was probably the ovary or pancreas; the remaining patient was suffering from Hodgkin's disease. All of the patients with the exception of the last died within 18 months of the onset of the ischaemic changes. In some the malignancy remained undiagnosed until the patient's death and in others was advanced when eventually discovered. It is suggested that malignant disease may give rise to digital ischaemia and that it may be the presenting or only symptom. Patients who suddenly develop “Raynaud's disease” in whom the accepted causes have been excluded deserve the fullest investigation in an attempt to discover an occult neoplasm. © 1967, British Medical Journal Publishing Group. All rights reserved.