Delayed Neurovascular-Autoimmune Flare After Caffeine-Nicotine Challenge: A Self-Observed Biphasic Case

This self-observation report documents a delayed biphasic neurovascular flare following the Dimitriev Provocation Test, which involved combined administration of caffeine (380 mg) and nicotine (9 mg). The acute response consisted of vasospasm, adrenergic symptoms, and mottling, followed by a transient hyperemic phase and a late-phase flare-up characterized by ischemic digital pain, cyanosis, and vein engorgement. The observed pattern suggests a stimulant-induced unmasking of latent neurovascular or autoimmune dysregulation, potentially mediated by cytokine activation (e.g., IL-6, TNF-α) and autonomic imbalance. Continued stimulant use after the test likely sustained inflammatory signaling. This case proposes a novel pathophysiological model of delayed flare induced by neurostimulant challenge and may inform future diagnostics in vasospastic or autoimmune syndromes. Suggested biomarker investigations and immunological pathways are included.