A 24-year-old man with a 10-year history of heavy cigarette smoking (approximately 20 cigarettes per day) was evaluated for recurrent episodes of cold-induced hand erythema and bilateral digital clubbing, most pronounced in the thumbs (Fig. 1a). Nailfold videocapillaroscopy consistently revealed a scleroderma-like pattern [1], showing prominent megacapillaries and architectural disorganization, but notably without microhemorrhages (Fig. 1b). Immunological workup, repeated every six months for six years, remained persistently negative.
