Inflammation of single finger, Only when ill

[weeble]

I have an interesting problem my GP has been unable to diagnose so am hoping for a direction of specialist to look to.

When I get sick with flu or cold type symptoms I get a serious inflammation of my right index finger. Untreated with will last about a week until the skin dies and peels off, however it is painful swollen and the inflammation prevents movement. My GP has ruled out an infection which was my first thought with the cold.

This last instance, the Doctor treated me with Prednisone and the inflammation has reduced in a day, and now at 3 days the skin is dying and peeling.

The GP's initial thoughts were a strange presentation of Gout due to "slightly raised Uric acid levels", however there is no direct joint discomfort, the pain is coming purely from the inflammed skin.

This only happens on my right index finger and only when my immune system seems to be fighting something else.

I have had the finger x-rayed and it showed "no abnormalities" and I am waiting on other blood tests.

Does anyone have a suggestion about where to look next. While not life threatening this condition does cause me concern.

Thanks for your help.

[Tom Plamondon PA-C]

Hello,
Thank you for writing in.

You have reported a painful swollen index finger with desquamation. Symptoms start with flu or cold symptoms and last a week. Symptoms decrease with prednisone.

I agree that this is an odd presentation. My differential diagnosis would include:
- small vessel vasculitis (I would expect more than one finger to be involved)
- Raynauds (I would expect both hands to be involved)
- gout
- desquamation secondary to viral illness.

The reason for the latter diagnosis is that some viral illnesses cause rash and some viral illnesses localize the red, swollen skin to the hand (eg Kawasaki disease). Although Kawasaki disease occurs in children, the mechanism may be similar - ie a viral illness causing desquamation. Why this happens is unknown.

Take care and keep us posted.