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A 12-year-old girl of Asian genetic ancestry was referred with arthralgia and episodic colour changes affecting her hands and feet. She described her digits turning grey then blue, with painful paraesthesia, particularly in cold environments. She also had a history of intermittent periorbital swelling. On examination, there was pitting of several fingertips and restriction of hips and knees bilaterally. Cardiovascular and respiratory examinations were unremarkable, with no peripheral oedema and normal peripheral pulses.