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A 71-year-old Hispanic man presented to the Emergency Department (ED) complaining
of worsening right hand pain and discoloration for 2 days. He was discharged home
2 days prior from a neighboring hospital for a small bowel obstruction that was treated
conservatively. Additionally, the patient was being medically managed with intravenous
phenytoin as an inpatient for his long-standing seizure disorder. Physical examination
was remarkable for right hand cyanosis and edema to the thumb, second, third, and
fourth digits along the dorsal and volar aspects from the fingertips to the wrist
(Figure 1, Figure 2, Figure 3). Involved digits were extremely tender to palpation and aggravated by movement.
Radial and ulnar pulses were intact and overlying skin cool to the touch.
