Digital Ischemia and Gangrene Preceding Renal Neoplasm

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Abstract
Digital ischemia and progressive gangrene of the tips of fingers and toes have been associated in the past with neoplasm and may precede other manifestations of the tumor.1 This report describes a patient who developed, prior to the detection of a sarcomatoid carcinoma of the kidney, rapidly deteriorating cold-induced ischemia, hypergammaglobulinemia, and gangrene of the distal phalanges of the fingers. Following nephrectomy, improvement in digital ischemia and hypergammaglobulinemia was observed. PATIENT SUMMARY A 63-year-old woman noted the precipitous onset of cold-induced tenderness and blanching of her fingers followed by a prolonged period of cyanosis and rubor. Within three weeks, the patient developed small ulcerations and gangrenous changes of the tips of the thumb, index, and middle fingers of the right hand and the index and middle fingers of the left hand. The erythrocyte sedimentation rate (ESR) and serum gammaglobulin values were substantially elevated. Tests for antinuclear antibodies (ANA), rheumatoid

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