Author(s): Dr. Henna Naqash and Dr. Fayaz Wani.
A 50 – year old male, farmer, presented with complaints of abnormal sensations, pain and discoloration of hands & feet for last 7 months. He was a tobacco smoker with 15 pack – years of smoking. He h ad tachycardia, asynchronous pulses, dry purplish black toes, fingers and parts of adjacent hands and feet on examination. Investigations revealed leucocytosis, high ESR and protein S deficiency.