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A 26-year-old woman complained of painful blue discoloration of her fingers on exposure to cold temperatures. She recalled having several such episodes as a child but noted that they became much more frequent after she moved to Colorado from coastal Georgia. On a recent hike into the mountains, she felt increasing pain in her fingers and watched as they turned white, then blue, and finally became red and swollen. Once her hands were warm again, they returned to normal. On examination, her nailfolds exhibited no telangiectasias or dilated capillary loops, and she had no digital ulcers. Her lungs were clear to auscultation, and all joints were clinically normal.