Buerger's disease (Thromboangiitis obliterans): a diagnostic challenge

Jorge, Vanda Cristina; Araújo, Ana Carolina; Noronha, Carla; Panarra, António; Riso, Nuno; Riscado, Manuel Vaz

doi:10.1136/bcr.08.2011.4621

Cited by 11 publications

(8 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical management in established disease is limited, with vascular bypass rarely successful. 14 On account of the aforementioned, inevitable wound-healing problems, it has been suggested 16 that definitive amputation and reconstruction of a digit or limb in non-infected cases should be postponed until after the patient ceases tobacco use and clearly demarcated dry gangrene is established. For similar reasons, minimal judicious surgical debridement should be performed if clinically indicated.…”

Section: Discussionmentioning

confidence: 99%

Homozygous Factor V Leiden Thrombophilia in a Patient With Histologically Confirmed Thromboangiitis Obliterans

Mensa

Dobbs

Jessop

et al. 2019

Clin Med Insights Case Rep

View full text Add to dashboard Cite

Thromboangiitis obliterans (TAO) is a vasculitis characterised by segmental occlusions of small to medium-sized arteries and superficial veins, and a curious predilection for young male smokers. The exact aetiology remains unknown. Current theories postulate it is an autoimmune endarteritis, triggered by some constituent of tobacco and occurring in genetically susceptible individuals. The disease can pose a diagnostic challenge, requiring a high degree of clinical suspicion, particularly in male smokers aged between 20-45 presenting with peripheral ischaemia. The fundamental principle of management is absolute tobacco abstinence. In this article, we report the case of a 27-year-old man who presented with infected, chronic wounds of his upper and lower extremities. He was initially treated with antibiotics and surgical debridement. Unfortunately he went on to develop a protracted course of complications due to poor wound healing ultimately leading to amputation of several digits. A diagnosis of TAO was suspected, and this was later confirmed histologically. Incidentally and of note, the patient was also found to be homozygous for factor V Leiden. An association between TAO and hypercoagulable states, specifically heterozygous factor V Leiden mutation, has been previously described. It is unclear if a synergistic effect between TAO and homozygosity for factor V Leiden may have contributed to the severity and unremitting nature of our patient’s symptoms. We present this case in order to highlight the importance of early recognition of the condition and the need to offer comprehensive smoking cessation support in order to prevent amputation and other complications of poor wound healing.

show abstract

Section: Discussionmentioning

confidence: 99%

Homozygous Factor V Leiden Thrombophilia in a Patient With Histologically Confirmed Thromboangiitis Obliterans

Mensa

Dobbs

Jessop

et al. 2019

Clin Med Insights Case Rep

View full text Add to dashboard Cite

show abstract

“…Furthermore, the patient had a history of smoking for about fifty years. Smoking is associated with Raynaud's phenomenon[ 11 ] and Buerger's disease[ 12 ] and impaired peripheral vasculature endothelium-dependent vasorelaxation, which may be considered a risk factor. This report suggests us to pay close attention to the potential risk of amphotericin B-induced acrocyanosis and elevated serum creatinine, especially in elderly patients with impaired renal function and smoking.…”

Section: Discussionmentioning

confidence: 99%

“…This report suggests us to pay close attention to the potential risk of amphotericin B-induced acrocyanosis and elevated serum creatinine, especially in elderly patients with impaired renal function and smoking. [ 11 12 ]…”

Section: Discussionmentioning

confidence: 99%

Amphotericin B liposome-induced acrocyanosis and elevated serum creatinine

et al. 2016

View full text Add to dashboard Cite

A 77-year-old male patient developed acrocyanosis and pain after treatment with amphotericin B liposome 150 mg daily intravenously for disseminated histoplasmosis, and subsequently developed elevated serum creatinine. Amphotericin B liposome was discontinued, and anisodamine was used intravenously to treat acrocyanosis and pain induced by amphotericin B liposome for 9 days and patient was cured. Naranjo adverse drug reaction probability scale score was 5, the World Health Organization-Uppsala Monitoring Centre criteria: Probable, indicating a probable adverse reaction to amphotericin B liposome.

show abstract

“…28 This linear deposition is observed along the length of the internal elastic lamina. 29 Recently, Jorge et al 30 reported that ESR, C3, and C4 values were abnormal in a 34-year-old male patient with ulcers in the fingertips and a history of heavy smoking.…”

Section: Variablesmentioning

confidence: 99%

Humoral and cellular immune response to Buerger’s disease

et al. 2020

View full text Add to dashboard Cite

Objective Thromboangiitis obliterans is a nonatherosclerotic occlusive disease, affecting small to moderate sized arteries of the upper and lower extremities, leading to progressive inflammation and clot formation. However, the role of humoral and cell-mediated immunity in the development of this disease has not been clearly identified. The present study was intended to investigate the humoral and cellular immune response in patients with Buerger’s disease with different disease severity. Methods In an observational study, 80 male patients with Buerger’s disease were included and categorized into three groups (mild, moderate, and severe) based on clinical manifestations. After blood sampling, cellular phenotypes were determined, and erythrocyte sedimentation rate, immunoglobulins (Ig) A, M, G, and E, as well as C3 and C4 components of the complement system and complement hemolytic activity (CH50) were measured. Results The mean age of the patient was 42.85 ± 8.39 years. Pulse abnormality, cold intolerance, and claudication were the most common symptoms. Eleven (13.75%), 46 (57.50%), and 23 (28.75%) patients had mild, moderate, and severe symptoms. Regression analyses showed that the presence of severe symptoms was significantly associated with elevated erythrocyte sedimentation rate and C4 levels ( p < 0.05). Conclusion Buerger’s disease in severe cases was associated with increased erythrocyte sedimentation rate and abnormal C4 levels. The alterations in these inflammatory biomarkers might be due to a secondary inflammatory response to the presence of ulcer or gangrene and the inflammatory process in patients with severe symptoms.

show abstract

Buerger's disease (Thromboangiitis obliterans): a diagnostic challenge

Cited by 11 publications

References 12 publications

Homozygous Factor V Leiden Thrombophilia in a Patient With Histologically Confirmed Thromboangiitis Obliterans

Homozygous Factor V Leiden Thrombophilia in a Patient With Histologically Confirmed Thromboangiitis Obliterans

Amphotericin B liposome-induced acrocyanosis and elevated serum creatinine

Humoral and cellular immune response to Buerger’s disease

Contact Info

Product

Resources

About