Elementary, Dr. Watson? (Dark Girl, White Hands)

You’re watching this teenager closely for further developments. Since the 17-year-old moved to the northeast from the Caribbean, during the winter months her fingers have become cold and white intermittently. She also remarked about shortness of breath.

She presented initially with a 1-month history of violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands.

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How often do symptoms of Raynaud's syndrome presage systemic conditions, and which ones? What is unusual about this case? (Hint: It's not her skin color.)

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