Medical history A 45 year-old female patient, G3P3A0, seeks the Emergency Department complaining of intense pain and cyanosis concerning all her left-sided digits, except for the thumb, hallux, 4th and 5th pododactyls, in association with a generalized erythematous rash. She denies fever or asthenia. She claims having had an amputation of all her right foot toes 10 years ago, and of two right hand chirodactyls in subsequent years, all due to cyanosis, pain and paresthesias similar to those she is presently experiencing. Her medical history is also notable for systemic hypertension, dyslipidemia, hypothyroidism, an acute myocardial infarction in 2015 and chronic renal disease requiring dyalisis in the last year. Image 1: Photograph of the patients feet.Image 2: Photograph of the patients right hand in pronation.Image 3: Photograph of the patients left hand in pronation.Image 4: Photograph of the patients left hand in supination. Question:Based on this clinical scenario and the presented images, what is the most likely diagnosis? Antiphospholipid antibody syndrome Type I cryoglobulinemia Primary Raynaud phenomenon Polyarteritis nodosa Time is Up! Time's up
