Case Study: Atypical Raynaud's Phenomenon Flare-up Triggered by Emotional Stress

Case at a Glance

A 36-year-old female with a long-standing diagnosis of Raynaud's phenomenon presents with a severe, localized flare-up characterized by swelling, pain, and pruritus, uniquely triggered by emotional stress rather than cold exposure.

Patient's Story

The patient, a 36-year-old female, reports a history of Raynaud's phenomenon diagnosed approximately 17 years prior. She recalls her initial symptoms starting during university, noting a pattern where flare-ups coincided with periods of high academic pressure, such as end-of-semester examinations. She explicitly states that cold temperatures have never been a trigger for her symptoms. After being symptom-free for nearly a decade, she is now experiencing a severe recurrence during warm summer weather, involving intense swelling, pain, and itchiness in one finger, which she attributes directly to recent emotional stress and anxiety.

Initial Assessment

The patient presents with an acute, non-cold-induced vasospastic episode affecting one finger. Chief complaints are significant digital edema (swelling), pain, and intense pruritus. The patient is afebrile and otherwise systemically well. She strongly associates the onset of this flare-up with a period of heightened emotional stress. The presentation is unusual given the absence of a cold trigger and the occurrence during a warm season, following an 8-year remission period.

The Diagnostic Journey

The diagnosis of Raynaud's phenomenon was established when the patient was approximately 19 years old. The historical presentation was consistently linked to psychological stressors rather than environmental cold exposure. This pattern has been re-established with the current episode. The long remission period followed by a sudden, severe recurrence suggests a change in the patient's stress levels or physiological response to stress.

Final Diagnosis

Primary Raynaud's Phenomenon, with emotional stress identified as the primary trigger.

Treatment Plan

The patient's primary query is regarding the management of acute, stress-induced flare-ups. The current challenge is to find effective strategies for immediate symptom relief (pain, swelling, itchiness) when traditional warming measures are irrelevant. A comprehensive plan should include both acute management and long-term preventative strategies. This involves exploring stress-reduction techniques (e.g., mindfulness, biofeedback, cognitive-behavioral therapy) to mitigate the primary trigger. Pharmacological intervention, such as calcium channel blockers, may be considered if conservative measures are insufficient to control symptom severity and frequency.

Outcome and Follow-up

The patient is currently experiencing significant discomfort from an acute flare-up. She is seeking immediate strategies to manage the pain and swelling. Recommended follow-up includes a consultation with her physician to discuss stress management resources and to re-evaluate her condition, given the long remission and severity of the current episode. Further investigation to rule out secondary causes may be warranted if the pattern or symptoms evolve.