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.
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Published online: September 14, 2012
Accepted: July 2, 2012
Received in revised form: March 8, 2012
Received: January 15, 2012
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.