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Mixed Connective Tissue Disease and Hyperbaric Oxygen Therapy
Lauren Chmielewski MD
David Rowe MD
University Hospitals Case Medical Center, Cleveland OH
2013-03-13
Presenter: Lauren Chmielewski MD
Affidavit:
All of the above work represents the original work of the resident.
Director Name: Hooman Soltanian MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Mixed connective tissue disease (MCTD) often presents with Raynaud phenomenon, swollen hands, and puffy fingers. [1] Severe forms can lead to vasculitis and acral ulcers that are often recalcitrant to common wound therapies. [2] Hyperbaric oxygen therapy (HBOT) has been an important adjunct in the management of ischemic wounds that are often recalcitrant to other modalities. [3] HBOT has been shown to stimulate fibroblast proliferation and differentiation, increase collagen formation and cross-linking, augment neovascularization, and stimulate leukocyte-mediated microbial killing. [3]
This is a case of a 53 year old female with a history of MCTD, Sjogrens, Raynauds, and lupus who presented with worsening hand and foot pain. The pain was thought to be autoimmune or neuro-vasospastic in etiology. She had tried and failed multi-modality therapy. Her workup was significant for normal zinc and albumin, ANA +, anti-SM/RNP +, anti-SSA +, anti-SSB +. A non-invasive vascular study revealed the perfusion to all extremities to be normal. Medications included chronic immunosuppression to suppress inflammation, epoprostenol sodium, topical steroids, antibiotics, antifungals, and antivirals with only sporadic improvement. Ultimately she was started on HBOT as adjunctive therapy. She underwent 60 treatments at 2.0 ATA x 90 minutes, without air breaks. After HBOT, she has had significant improvement in both pain and ulceration.
However, challenges still remain. Her medical conditions of Raynaud's, lupus, MCTD, Sjogren's are ongoing battles. Continued study and interdisciplinary care is necessary for success in the long term. HBOT may become a helpful adjunct for complicated cases of MCTD-related ulceration and pain.
