Cold, White Fingers

January 17, 2014

This teen has had violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet for about a month this winter as well as intermittent shortness of breath since she moved to the northeast from the Caribbean. What's in your differential?

This teen’s fingers become cold and white intermittently during the winter months since she moved to the northeast from the Caribbean. She has had violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet for about a month as well as intermittent shortness of breath.

Your dx?