Picture Quiz: Limited cutaneous scleroderma (CREST syndrome)

Case history

A 65 year old woman developed a lump on the tip of her right ring finger that became painful, ulcerated, and discharged a white material (figure).

Questions

1. What is the abnormality on the hand x rays?

2. What are the two most likely causes of the white material discharging from the finger?

3. What is the underlying diagnosis?

4. What other manifestations of this conditions might affect this patient's hands?

Answers

1. The x rays show calcinosis.

2. The white discharge is most likely to be calcific deposits. It may also be pus if the finger has become infected.

3. Limited cutaneous scleroderma (or CREST syndrome).

4. Raynaud's phenomenon; ischaemia and gangrene of the fingers; skin oedema, thickening, tightening, and ulceration; joint contractures; nail fold capillary dilation and dropout; and …