A Case of Raynaud's Phenomenon of both Feet in a Rock Drill Operator with Hand-arm Vibration Syndrome

Choy, Nari; Sim, Chang Sun; Yoon, Jae Kuk; Kim, Suk Hwan; Park, Hyoung Ook; Lee, Ji Ho; Yoo, Cheol In

Abstract

BACKGROUND: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report of this entity in Korea.
CASE REPORT
A 58-year-old male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale.
CONCLUSIONS
The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."