A 39-year-old man, with no personal history of interest except for subclinical hypothyroidism, was referred from primary care for assessment of a purplish discolouration of the distal phalanx of the second, third and fourth fingers of both hands for 15 days, in addition to a sensation of coldness in the aforementioned areas; the lesions were persistent in both warm and cold environments, and no previous episodes of pallor or blushing were observed. No family history of interest was found. The patient was not taking any vasoconstrictor medication.
Physical examination revealed purplish discolouration and coldness at the distal ends of both hands in a fairly symmetrical manner, with these changes being more noticeable in the second, third and fourth fingers. The distal pulses were preserved, and no other anatomical areas were affected. No sclerodactyly, punctate scars or other significant findings suggestive of scleroderma were observed at this time. Cardiopulmonary examination revealed no abnormalities.
Several complementary tests, analytical and imaging tests were performed. Blood count, electrolytes, coagulation, liver function, renal function, arterial blood gases, urinalysis, erythrocyte sedimentation rate, complement levels, immunoglobulins, cryoagglutinins, cryoglobulins and tumour markers were normal. A thyroid function study showed subclinical hypothyroidism, with normal antithyroglobulin and antiperoxidase antibodies. HBV, HCV, HIV and syphilis serologies were negative.

Immunology revealed positive ANA titre 1/2560 with nucleolar pattern and negative anti-DNA, ENA, anticardiolipin, scl70, anticentromere and rheumatoid factor antibodies. Chest CT scan was strictly normal.
Two months later the patient began to present sclerodactyly and punctate scars on the finger tips and symmetrical induration of the presternal skin and laterocervical region. Treatment was started with pentoxifylline, oral corticosteroids in a descending pattern and azathioprine, with good control of his pathology.