Rheumatology Case 10

A single 35 year-old woman with a history of Raynaud’s phenomenon since 1990 came to the Rheumatology outpatient clinic for evaluation. Her past medical and family history were unremarkable. Physical examination showed that the hands were cold with a bluish appearance and livedo reticularis was present on the lower extremities (figure). Immunological evaluation showed: positive antinuclear antibodies at low titer (1/80), positive anticardiolipin antibodies, both IgG and IgM (280 IU and 150 IU respectively, normal value <100 IU). The rest of the immunological evaluation was negative. What is the differential diagnosis?
1. Systemic lupus erythematosus  
2. Progressive systemic sclerosis  
3. Primary antiphospholipid syndrome
4. Atrophic blanche  




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