Case Presentation: A 33 year old female with reported history of recurrent ‘ear infections’ presented with acute ischemia of bilateral digits of her hands and feet after one month of bilateral hand and foot paraesthesia. Labs on admission showed white blood cell count 11.08 K/uL, hemoglobin 12.5 g/dL, platelet count 622 K/uL, ESR 107 mm/hr, [...]