Clinical Cases
Real-world case studies with capillaroscopic images, interpretation, and clinical correlation.
Case-Based Learning
Clinical cases demonstrate practical application of capillaroscopic interpretation in real-world scenarios. Each case card includes diagnosis-focused clinical context, structured capillaroscopy interpretation, and key findings designed for rapid review and searchability.
Cases are organized by diagnosis and pattern type, allowing targeted study of specific conditions and presentations. Interactive viewer datasets are progressively added as each case package is finalized.
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MPO-ANCA Vasculitis with Rapidly Progressive Glomerulonephritis
A 57-year-old man with newly diagnosed MPO-ANCA vasculitis and rapidly progressive glomerulonephritis.
Author: Gema María Lledó Ibáñez
Clinical context: The patient presented with renal failure and nephritic syndrome, and kidney biopsy confirmed rapidly progressive glomerulonephritis in the setting of MPO-ANCA vasculitis.
Capillaroscopy: Capillaroscopy shows mildly reduced density (7.0 capillaries/mm), frequent capillary dilations, hemorrhages, and no giant capillaries, consistent with a non-specific microvascular pattern.
Key Capillaroscopic Findings:
- • Mild capillary density reduction (7.0/mm)
- • Frequent capillary dilations (58.2%)
- • Hemorrhages (0.5/mm), without giant capillaries
Anti-Mi2β Dermatomyositis in Active Disease
A 32-year-old woman with active anti-Mi2β-positive dermatomyositis and marked microvascular damage on capillaroscopy.
Author: Gema María Lledó Ibáñez
Clinical context: After 3 months of progressive symptoms, diagnosis was established based on proximal muscle weakness, Gottron papules, heliotrope rash, and hyperCKemia (~2500).
Capillaroscopy: There is marked capillary loss (4.8/mm), architectural disorganization, frequent dilations, giant capillaries, and abnormal/branched shapes, indicating severe active microangiopathy.
Key Capillaroscopic Findings:
- • Severe capillary loss (4.8/mm)
- • Giant capillaries (8.8%) and frequent dilations (59.4%)
- • Abnormal/branched capillaries (32.1%) with vascular remodeling
Limited Cutaneous Systemic Sclerosis (ACA+) with Active Cutolo Pattern
A 38-year-old woman with limited cutaneous systemic sclerosis, anti-centromere antibodies, and established active microangiopathy.
Author: Gema María Lledó Ibáñez
Clinical context: This case includes a 5-year history of Raynaud's phenomenon, esophageal dysmotility, and interstitial lung disease with an NSIP pattern, without current indirect echocardiographic signs of pulmonary hypertension.
Capillaroscopy: Capillaroscopy shows marked capillary loss (5.3/mm), frequent dilations, high prevalence of giant capillaries (27.5%), and hemorrhages, matching an active Cutolo pattern.
Key Capillaroscopic Findings:
- • Marked capillary loss (5.3/mm)
- • High frequency of giant capillaries (27.5%)
- • Frequent capillary dilations (61.6%) with hemorrhages
Systemic Sclerosis with anti-U3 RNP: Late Microangiopathy
Patient with systemic sclerosis, anti-U3 RNP antibodies, and severe microvascular disease with features of the late Cutolo pattern.
Author: Miguel Antonio Mesa Navas
Clinical context: Patient under follow-up by internal medicine, in whom a positive ANA was documented, with findings compatible with nonspecific interstitial pneumonia. The patient had an ANA titer greater than 1:1280 with an AC-9 granular pattern. Subsequent studies showed high-titer positivity for anti-U3 RNP antibodies. The patient presented with salt-and-pepper pigmentation, generalized cutaneous sclerosis, and sclerodactyly.
Capillaroscopy: There is marked capillary loss (4.9/mm), architectural disorganization, frequent dilations, giant capillaries in 14.9% of capillaries, and abnormal or ramified forms. This pattern was classified by the CAPI-Detect algorithm as active; however, due to the frequent features characteristic of late-stage involvement, it was ultimately classified as such in the final report.
Key Capillaroscopic Findings:
- • Marked capillary loss (4.9/mm)
- • Giant capillaries (14.9%)
- • Architectural disorganization
- • Hemorrhages indicating persistent vascular damage
Anti-NXP2 Dermatomyositis with Capillaroscopic Improvement
A 21-year-old woman with anti-NXP2-positive dermatomyositis followed with two capillaroscopies before and after immunosuppressive treatment.
Author: Luis Saez Comet
Clinical context: The patient developed progressive proximal weakness, dysphagia, heliotrope erythema, malar and facial erythema, and scaly cutaneous lesions, with CK elevation up to 2503 U/L and a positive myositis panel for anti-NXP2 antibodies. After corticosteroid and immunosuppressive treatment, she improved clinically and analytically.
Capillaroscopy: The first study shows an active scleroderma/myositis-like microangiopathy with severe capillary loss, giant capillaries, arborizing ramifications, microhemorrhages, architectural disorganization, and avascular areas. The follow-up study shows regression to a non-specific pattern with improved density and disappearance of giant capillaries and hemorrhages.
Key Capillaroscopic Findings:
- • Initial severe capillary loss (3.56/mm) with giant capillaries (21.5%)
- • Initial microhemorrhages and marked architectural disorganization
- • Follow-up density improved to 7.07/mm, with disappearance of giant capillaries and hemorrhages
Anti-TIF1γ Dermatomyositis with Scleroderma-Like Pattern
A 67-year-old man with chronic anti-TIF1γ-positive dermatomyositis and a scleroderma-like capillaroscopy pattern.
Author: Franklin Uguña Sari
Clinical context: Two-year history of V-neck lesions and hypomyopathic weakness on chronic low-dose methotrexate and prednisone.
Capillaroscopy: Capillaroscopy shows severely reduced capillary density (2.7/mm), architectural disorganization, frequent dilations, giant capillaries, and abnormal/ramified forms (2/3 on the semi-quantitative scale), consistent with a scleroderma-like pattern.
Clinical images
Key Capillaroscopic Findings:
- • Severe capillary loss (2.7/mm)
- • Giant capillaries (36.7%) and frequent dilations (41.1%)
- • Abnormal or ramified capillaries (37.8%)
- • Architectural disorganization