- A clinical case of recurrent cold acral foot lesions in a child: diagnostic challenges
A clinical case of recurrent cold acral foot lesions in a child: diagnostic challenges
Modern Pediatrics. Ukraine. (2025).8(152): 120-125. doi: 10.15574/SP.2025.8(152).120125
Volianska L. A.1, Boyarchuk O. R.1, Burbela E. I.1, Chubata O. B.2, Mudryk U. M.1
1I. Horbachevsky Ternopil National Medical University, Ukraine
2Ternopil Regional Children's Hospital, Ukraine
For citation: Volianska LA, Boyarchuk OR, Burbela EI, Chubata OB, Mudryk UM. (2025). A clinical case of recurrent cold acral foot lesions in a child: diagnostic challenges. Modern Pediatrics. Ukraine. 8(152): 120-125. doi: 10.15574/SP.2025.8(152).120125.Article received: Jun 09, 2025. Accepted for publication: Dec 15, 2025.
Manifestations of transient vasospasm of peripheral arteries and arterioles are an infrequent phenomenon in pediatric age, which always prompts an in-depth examination of the patient due to the need to differentiate the causes of its origin and differentiate its nature:primary or secondary. A clinical case of longitudinal observation of a patient for 4 years with Raynaud's syndrome is described.
Aim – to increase the awareness of doctors about Raynaud's phenomenon, clinical features of its course in childhood, differentiation of the nature of occurrence, treatment and prevention options based on the analysis of the observation of a clinical case.
The presented clinical case demonstrates the course of episodic-recurrent acropathia (three episodes during 4 years of observation) with damage to the skin and small vessels of the lower extremities in a child of primary school age, associated with the winter season, with a predominant lesion of the toes in the form of whitening, soreness, the appearance of papules, hemorrhagic elements and epidermolysis. The absence of systemic disorders and minimal changes in laboratory parameters justify the importance of dynamic clinical monitoring of children with recurrent acroischemic manifestations and illustrate the need for an interdisciplinary approach (rheumatologist, dermatologist, immunologist, vascular surgeon), especially with the progression of symptoms, the appearance of painful elements, necrosis or hemorrhagic changes. Verification of the clinical diagnosis remains a prospect subject to monitoring of autoantibodies, capillaroscopy evaluation, examination for genetic autoinflammatory syndromes, and the effectiveness of empirical treatment.
This clinical case demonstrates the need to raise awareness of systemic autoimmune diseases in primary care pediatricians and family medicine physicians, especially in cases of recurrent and seasonally associated skin and vascular lesions. The observation was performed in accordance with the principles of the Declaration of Helsinki. Written consent was obtained from the patient's mother for the publication of its results.
The authors declare that there is no conflict of interest.
Keywords: Raynaud's disease, Raynaud's syndrome, children.
REFERENCES
1. Boyarchuk O, Kuka A, Yuryk I. (2022). Clinical and autoantibody phenotypes of juvenile dermatomyositis. Reumatologia. 60(4): 281-291. https://doi.org/10.5114/reum.2022.119045; PMid:36186835 PMCid:PMC9494788
2. Boyarchuk O, Volianska L. (2023). Autoimmunity and long COVID in children. Reumatologia. 61(6): 492-501. https://doi.org/10.5114/reum/176464; PMid:38322108 PMCid:PMC10839920
3. Di Donato S, Huang S, Pauling JD et al. (2024, Oct). Clinically relevant differences betwee nprimary Raynaud's phenomenon and secondary to connective tissue disease. Semin Arthrit is Rheum. 68: 152521. Epub 2024 Jul 18. https://doi.org/10.1016/j.semarthrit.2024.152521; PMid:39089171
4. Goldman RD. (2019, Apr). Raynaud phenomenonin children. Can Fam Physician. 65(4): 264-265. PMID: 30979757; PMCID: PMC6467660.
5. Herrick AL. (2019, Jun). Raynaud's phenomenon. J Scleroderma Relat Disord. 4(2): 89-101. https://doi.org/10.1177/2397198319826467; PMid:35382391 PMCid:PMC8922643
6. Nawaz I, Nawaz Y, Nawaz E, Manan MR, Mahmood A. (2022, Jan 28). Raynaud's Phenomenon: Reviewing the Pathophysiology and Management Strategies. Cureus. 14(1): e21681. PMID: 35242466; PMCID: PMC8884459. https://doi.org/10.7759/cureus.21681
7. Rigante D, Fastiggi M, Ricci F et al. (2017, May). Handy Hints About Raynaud's Phenomenonin Children: A Critical Review. Pediatr Dermatol. 34(3): 235-239. https://doi.org/10.1111/pde.13129; PMid:28523890
8. Temprano KK. (2016, Mar-Apr). A Review of Raynaud's Disease. Mo Med. 113(2): 123-6. PMID: 27311222; PMCID: PMC6139949.
9. Tervi A, Ramste M, Abner E et al. (2024, Sep 11). Genetic and functional analysis of Raynaud's syndrome implicates loci in vasculature and immunity. Cell Genom. 4(9): 100630. Epub 2024 Aug 13. https://doi.org/10.1016/j.xgen.2024.100630; PMid:39142284 PMCid:PMC11480858
10. Ture HY, Lee NY, Kim NR, Nam EJ. (2024, Jul 23). Raynaud's Phenomenon: A Current Update on Pathogenesis, Diagnostic Workup, and Treatment. Vasc Specialist Int. 40: 26. https://doi.org/10.5758/vsi.240047; PMid:39040029 PMCid:PMC11266082