A 50-year-old lady presented with a 1-month history of melena and easy fatigability. Except for pallor there were no other positive findings on examination. There was no history of RP or gastro-esophageal reflux. Her haemoglobin was 5.8 g/dl with normal platelet count. Urine microscopy, hepatic and renal functions tests were normal. The upper gastroduodenoscopy revealed gastric antral vascular ectasia (GAVE), also known as ‘watermelon stomach’ (Fig. 1A). The patient was transfused packed red blood cells and Argon plasma photocoagulation was done to stop the bleeding. Her evaluation for GAVE showed positive ANA and anti-Centromere antibody. A nailfold capillaroscopy (Fig. 1B)
Nailfold capillaroscopy (NFC) is a simple, noninvasive, outpatient procedure that permits direct visualization of capillaries through the skin of terminal nailfold with the help of digital microscope. Autoimmune Rheumatic diseases(AIRDs) are associated with abnormalities of microcirculation(microangiopathy) that can be visualized with NFC. Among all AIRDs, systemic sclerosis (SSc) is known to have prominent microangiopathy that contributes to Raynaud's phenomenon, digital ulceration, and pulmonary hypertension in this disease. These microcirculation abnormalities are labeled “the scleroderma pattern”. They occur in a clearly defined sequence of “early”, “active”, and “late” pattern and correlate with internal organ involvement. Apart from SSc, microangiopathy can be seen in dermatomyositis and the scleroderma-spectrum disorders. NFC is invaluable in differentiating primary from secondary Raynaud's phenomenon. NFC despite being simple and noninvasive is underutilized in clinical practice.
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