Hello All,
I had an interesting case this am. A 5yr old girl , yes 5, with symptoms of discolored upper and sever lower extremity digits. Now has sores on the 3rd toe, bilaterally R>L.  She was recently treated for Lyme's.  The patient also lives in an old farm house- wood flooring and does not wear socks or slippers in house. This is the northeast and as you all know....it's been a cold winter so far!
The order was for Raynaud's of the lower extremity as they are the most symptomatic and she was referred by a podiatrist. The Brachial pulses were normal with normal pressures bilaterally(and ankles too).
Normal bilateral TBI's. PPG waveforms in the bilateral lower extremity digits were either normal or vasospasm in appearance (R>L) throughout.
I'm thinking this is some kind of autoimmune disease causing this. Have any of you seen a patient so young with this presentation? What are your thoughts?
I welcome your input?
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