Clinical Image: A Novel Capillaroscopic Morphologic Anomaly in a Smoker: The “∩‐Shaped” Megacapillary
Year: 2025
Type: article
Study design: Case Report
Abstract: A 60-year-old White female with a 30-year history of smoking, no history of Raynaud phenomenon or digital ulcers, presented with persistent bilateral acrocyanosis. Nailfold videocapillaroscopy performed in October 2024 revealed the initial stages of a “scleroderma-like” pattern, characterized by enlarged capillaries, pericapillary edema, and megacapillaries. Among these, one vessel exhibited a distinctive ∩-shaped downward curvature, with an apical diameter measuring 50.7 μm, resembling a “kneeling” configuration. This peculiar morphology has not been previously described in the literature and raises questions about its etiology. Systemic autoimmune diseases were excluded based on a detailed clinical examination and negative results for antinuclear antibodies, extractable nuclear antigens, antineutrophil cytoplasmic antibodies, and anticardiolipin antibodies. Cardiopulmonary and abdominal imaging were unremarkable. The observed capillaroscopic pattern, in the absence of systemic involvement, may indicate chronic smoking–related endothelial stress rather than connective tissue disease. This report highlights the importance of recognizing smoking-related capillaroscopic changes to avoid misdiagnosis and underscores the need for smoking cessation counseling to prevent further microvascular damage. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Source: ACR Open Rheumatology
DOI: 10.1002/acr2.70015
Author: Angelo Nigro
Institution: Ospedale Madonna Delle Grazie
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,550
OpenAlex ID: W4407689202