Digital Ischemia in Patients with Solid Tumors: A Case Report and Review of the Literature

Digital ischemia is a rare paraneoplastic phenomenon associated with various malignancies, especially adenocarcinomas. We reported a case of digital ischemia onset during treatment with capecitabine + oxaliplatin, letrozole and epoetin-beta in a 75-year old woman with colon and breast cancer and a secondary hepatic lesion. A literature review disclosed 68 cases of solid neoplasms associated with digital ischemia. The proposed mechanisms of such clinical manifestations are various: vasospasm due to sympathetic hyperactivity, arteritis induced by tumour antigen-antibody complexes deposition or as consequence of immune deregulation, blood hyperviscosity, hypercoagulability or peripheral thrombosis. In the present case, clinical and laboratory evaluations failed to reveal evidence of thrombosis, arteritis, inherited or acquired hypercoagulable state and we postulated the peripheral vasospasm and the sympathetic activity (possibly due to chemotherapy drugs) as potential causes of the digital ischemia.