The following lab tests were normal: Complete metabolic profile (except mildly elevated AST at 48), complete blood count, alkaline phosphatase, calcium, albumin, CRP, TSH, ENA panel, ANA panel, anti- DS DNA normal, anticardiolipin, compliment tests, ANCA. Lupus anticoagulant was indeterminant.
Non-invasive upper and lower limb arterial studies including pre/post exercise ankle brachial index. Popliteal artery entrapment maneuvers, erythromelalgia protocol were normal. All digits showed delayed rewarming following ice immersion, consistent with primary vasospasm (Pictures 6 & 7).
EMG, Thermoregulatory sweat test (Picture 8- to look for small fiber neuropathy), and autonomic reflex screen were normal. Tilt table test showed a tendency to orthostasis. CT Angiography and MRI of the knees performed elsewhere were normal (Picture 9).
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