ADIPOCYTE–MYOFIBROBLAST TRANSITION IN SKIN FIBROSIS
41. Dulauroy S, Di Carlo SE, Langa F, Eberl G, Peduto L. Lineage tracing and genetic ablation of ADAM12⫹ perivascular cells identify a major source of profibrotic cells during acute tissue injury. Nat Med 2012;18:1262–70. 42. Bochet L, Lehuede C, Dauvillier S, Wang YY, Dirat B, Laurent V, et al. Adipocyte-derived fibroblasts promote tumor progression and contribute to the desmoplastic reaction in breast cancer. Cancer Res 2013;73:5657–68. 43. Desai VD, Hsia HC, Schwarzbauer JE. Reversible modulation of myofibroblast differentiation in adipose-derived mesenchymal stem cells. PloS One 2014;9:e86865. 44. Duffield JS, Lupher M, Thannickal VJ, Wynn TA. Host re-
1073
sponses in tissue repair and fibrosis. Ann Rev Pathol 2013;8: 241–76. 45. Rock JR, Barkauskas CE, Cronce MJ, Xue Y, Harris JR, Liang J, et al. Multiple stromal populations contribute to pulmonary fibrosis without evidence for epithelial to mesenchymal transition. Proc Natl Acad Sci U S A 2011;108:E1475–83. 46. Goritz C, Dias DO, Tomilin N, Barbacid M, Shupliakov O, Frisen J. A pericyte origin of spinal cord scar tissue. Science 2011;333: 238–42. 47. LeBleu VS, Taduri G, O’Connell J, Teng Y, Cooke VG, Woda C, et al. Origin and function of myofibroblasts in kidney fibrosis. Nat Med 2013;19:1047–53.
DOI 10.1002/art.39003
Clinical images: Achenbach’s syndrome (paroxysmal finger hematoma) with capillaroscopic evidence of microhemorrhages
The patient, a 49-year-old woman, was referred to our capillaroscopy unit because of “localized Raynaud’s phenomenon” and abnormal findings on capillaroscopic examination obtained elsewhere. She had experienced spontaneously occurring pain and bluish discoloration of the fingers approximately once per week for the last 4 years, predominantly affecting the proximal volar area of the middle fingers (A). Rarely, the episodes occurred in the index or ring fingers, but there was never simultaneous involvement of ⬎1 digit. The symptoms always started with swelling that lasted ⬃3 hours, progressing to development of bluish hematoma followed by livid coloration, which regressed after a few days. Concomitant with some of these episodes she noted the transient occurrence of “dots” at the nailbed. There was no association with physical strain or exposure to cold temperatures. Her medical history included goiter and uterine leiomyosarcoma requiring hysterectomy, followed by radiation therapy, chemotherapy, and surgical resections of extrauterine manifestations. Further history was unremarkable except for seldomly occurring migraine headaches (without antimigraine medication) and infrequent nicotine use. She had no signs of Raynaud’s phenomenon, and the results of further clinical and laboratory investigations, including immunologic screening, were normal or negative. Capillaroscopy of the right middle finger showed multiple severe hemorrhages (detail in B, overview in C) without any other alterations of capillary morphology or blood flow at any of the investigated fingers (second through fifth bilaterally). She was diagnosed as having paroxysmal finger hematoma (Achenbach’s syndrome), a rare benign condition of still unknown cause (1). Previous reports suggested that nailbed capillaries are not affected (2). However, the recurrent visible hemorrhages and the temporal association of the capillaroscopic abnormalities with recent symptoms in the right middle finger in this patient indicate that capillary microhemorrhages can occur in Achenbach’s syndrome. 1. Achenbach W. Paroxysmal hematoma of the hand. Medizinische 1958;52:2138–40. 2. Thies K, Beschorner U, Noory E, Zeller T. Achenbach’s syndrome revisited. Vasa 2012;41:366–70.
Marc Frerix, MD Katrin Richter, MD Ulf Mu ¨ller-Ladner, MD Walter Hermann, MD Justus-Liebig University Giessen Giessen, Germany and Kerckhoff Clinic Bad Nauheim Bad Nauheim, Germany
Copyright of Arthritis & Rheumatology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
41. Dulauroy S, Di Carlo SE, Langa F, Eberl G, Peduto L. Lineage tracing and genetic ablation of ADAM12⫹ perivascular cells identify a major source of profibrotic cells during acute tissue injury. Nat Med 2012;18:1262–70. 42. Bochet L, Lehuede C, Dauvillier S, Wang YY, Dirat B, Laurent V, et al. Adipocyte-derived fibroblasts promote tumor progression and contribute to the desmoplastic reaction in breast cancer. Cancer Res 2013;73:5657–68. 43. Desai VD, Hsia HC, Schwarzbauer JE. Reversible modulation of myofibroblast differentiation in adipose-derived mesenchymal stem cells. PloS One 2014;9:e86865. 44. Duffield JS, Lupher M, Thannickal VJ, Wynn TA. Host re-
1073
sponses in tissue repair and fibrosis. Ann Rev Pathol 2013;8: 241–76. 45. Rock JR, Barkauskas CE, Cronce MJ, Xue Y, Harris JR, Liang J, et al. Multiple stromal populations contribute to pulmonary fibrosis without evidence for epithelial to mesenchymal transition. Proc Natl Acad Sci U S A 2011;108:E1475–83. 46. Goritz C, Dias DO, Tomilin N, Barbacid M, Shupliakov O, Frisen J. A pericyte origin of spinal cord scar tissue. Science 2011;333: 238–42. 47. LeBleu VS, Taduri G, O’Connell J, Teng Y, Cooke VG, Woda C, et al. Origin and function of myofibroblasts in kidney fibrosis. Nat Med 2013;19:1047–53.
DOI 10.1002/art.39003
Clinical images: Achenbach’s syndrome (paroxysmal finger hematoma) with capillaroscopic evidence of microhemorrhages
The patient, a 49-year-old woman, was referred to our capillaroscopy unit because of “localized Raynaud’s phenomenon” and abnormal findings on capillaroscopic examination obtained elsewhere. She had experienced spontaneously occurring pain and bluish discoloration of the fingers approximately once per week for the last 4 years, predominantly affecting the proximal volar area of the middle fingers (A). Rarely, the episodes occurred in the index or ring fingers, but there was never simultaneous involvement of ⬎1 digit. The symptoms always started with swelling that lasted ⬃3 hours, progressing to development of bluish hematoma followed by livid coloration, which regressed after a few days. Concomitant with some of these episodes she noted the transient occurrence of “dots” at the nailbed. There was no association with physical strain or exposure to cold temperatures. Her medical history included goiter and uterine leiomyosarcoma requiring hysterectomy, followed by radiation therapy, chemotherapy, and surgical resections of extrauterine manifestations. Further history was unremarkable except for seldomly occurring migraine headaches (without antimigraine medication) and infrequent nicotine use. She had no signs of Raynaud’s phenomenon, and the results of further clinical and laboratory investigations, including immunologic screening, were normal or negative. Capillaroscopy of the right middle finger showed multiple severe hemorrhages (detail in B, overview in C) without any other alterations of capillary morphology or blood flow at any of the investigated fingers (second through fifth bilaterally). She was diagnosed as having paroxysmal finger hematoma (Achenbach’s syndrome), a rare benign condition of still unknown cause (1). Previous reports suggested that nailbed capillaries are not affected (2). However, the recurrent visible hemorrhages and the temporal association of the capillaroscopic abnormalities with recent symptoms in the right middle finger in this patient indicate that capillary microhemorrhages can occur in Achenbach’s syndrome. 1. Achenbach W. Paroxysmal hematoma of the hand. Medizinische 1958;52:2138–40. 2. Thies K, Beschorner U, Noory E, Zeller T. Achenbach’s syndrome revisited. Vasa 2012;41:366–70.
Marc Frerix, MD Katrin Richter, MD Ulf Mu ¨ller-Ladner, MD Walter Hermann, MD Justus-Liebig University Giessen Giessen, Germany and Kerckhoff Clinic Bad Nauheim Bad Nauheim, Germany
Copyright of Arthritis & Rheumatology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
