Abstract The case of an adult male with secondary Raynaud's phenomenon refractory to medical management and associated with cutaneous vasculitis who previously had been receiving interferon beta for multiple sclerosis treatment, is presented. The aggressiveness of the process required the interruption of the medication, the use of vasodilators, inhibitors of endothelin-1, bilateral thoracoscopic sympathectomy by video, peri-arterial interdigital botulinum toxin application in hands and immunosuppressive therapy with high dose corticosteroids and cyclophosphamide, obtaining arrest of the ischemic process, but with associated anatomical loss. (Acta Med Colomb 2014; 39: 81-84).