Joint pain, digital necrosis and acute kidney failure in small-vessel autoimmune disease

A 61-year-old female suffered from disseminated joint pain (both hands, elbows, knees, ankles) with a prominent Raynaud phenomenon in both hands for 4 months before admission due to nausea. Acute kidney failure of unknown origin was diagnosed and acral cyanosis of fingers II–IV of the left hand with beginning finger tip necrosis became Fig. 1. Left hand at admission.