Paraneoplastic Acral Vascular Syndrome

Paraneoplastic acral vascular syndrome involves an association between malignancy and Raynaud phenomenon, gangrene, or acrocyanosis of the fingers. Raynaud phenomenon is a transient digital ischemia resulting from vasoconstriction on exposure to cold temperatures or stressful situations. In its secondary form, it is usually associated with rheumatic disease and rarely occurs as a paraneoplastic phenomenon. We present the case of a 49-year-old man with no personal history of interest who smoked 80 cigarettes and drank 60 g of alcohol per day. He visited the emergency department with sudden-onset cyanosis on the first 3 fingers of the left hand that was preceded by cutaneous pallor with paresthesia and intense pain (Figure 1). He had no other symptoms that were indicative of systemic disease, and the remainder of the physical examination was unremarkable. His heartbeat was regular, with no murmurs, and the distal pulses were palpable and symmetrical in all 4 extremities. The coagulation study was normal, except for D-dimer, which was >5000 ng/mL. Prothrombin time and activated partial prothrombin time were normal. Arterial Doppler ultrasound showed that the blood supply reached