The blue (or purple) toe syndrome describes the development of a blue or violaceous discoloration in one or more toes in the absence of obvious trauma, serious cold-induced injury or disorders producing generalized cyanosis. The presence of blue toe syndrome requires the clinician to search for primary systemic vasculitides, as well as for malignancy, underlying infection, thrombosis, cardiovascular pathology and other diseases. An accurate diagnosis is critical because many of the causes threaten life or limb, but the patient’s medical history, accompanying non-dermatologic findings on physical examination and the use of discriminatory laboratory tests are usually more important than the nature of the cutaneous abnormalities. We describe the case of a 53-year-old Caucasian male patient presenting with blue toe syndrome as the initial manifestation of ANCA-associated vasculitis.
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