Treatment of multiple refractory ankle ulcerations in thromboangiitis obliterans

Abstract

Rationale:Thromboangiitis obliterans (TAOs, or Buerger's disease) present as a non-atherosclerotic segmental occlusive vasculitis within medium- and small-sized blood vessels. TAO frequently occurs in young adults and is associated with cigarette smoking. At present, there are no accurately defined treatments for TAO.Patient concerns:A 34-year-old Asian woman with a 20-year history of heavy cigarette smoking and recurrent, small, and self-limited lower limb ulcerations since adolescence, presented with persisting unhealed ulcerations on both ankles for 6 months. Her wound healing response was poor following the 2-month administration of colchicine, prednisolone, hydroxychloroquine, and mycophenolic acid.Diagnosis:The patient was diagnosed with TAO with hyperimmunoglobulin E and refractory ulcerations on her ankles.Interventions:The patient received monthly omalizumab (300 mg) and previous medications for 2 months and shifted to omalizumab and colchicine without mycophenolic acid and hydroxychloroquine because of onychomadesis, which was considered to be a possible adverse drug reaction.Outcomes:The wounds healed almost completely. The administration of omalizumab and colchicine will be continued until they the wounds are fully healed.Lessons:Mycophenolic acid has a limited function in TAO treatment, especially in cases of refractory skin ulcerations. Omalizumab can be a valuable treatment option for patients with TAO and hyperimmunoglobulin E.

Humoral and cellular immune response to Buerger’s disease

“…Thus, omalizumab, as an anti-IgE can be beneficial for the treatment of TAO. 33 In another study, levels of all serum Igs showed a significant rise in TAO patients as compared with controls. 34 This finding was also supported by the findings of Gulati et al 35 Garc ıa et al reported a significant increase in IgA levels of patients with Buerger's disease.…”

Integration of traditional Chinese medicine and nibble debridement and dressing method reduces thrombosis and inflammatory response in the treatment of thromboangiitis obliterans

“…Thromboangiitis obliterans (TAO) is a chronic occlusive disease characterized by segmental, non-suppurative inflammation, and intravascular thrombus formation (1). It mainly invades the limbs, especially the small and medium arteries and veins of the lower limbs, and then causes ischemic changes in the distal side of the affected limb (2). At present, TAO mainly presents as limb ischemia, pain, intermittent claudication, migrating phlebitis, extremity gangrene, secondary infection, and even disability (3,4).…”

Predictive value of serum VEGF, IL‑1 and TNF‑α in the treatment of thromboangiitis obliterans by revascularization

“…The immune system and inflammatory response play an important role in the pathogenesis of TAO. The interaction between inflammation and hemostasis increases the tendency of thrombosis, and chronic inflammation can induce endothelial damage ( 12 ). Vascular endothelial growth factor (VEGF) is an endogenous angiogenic growth factor that acts on vascular endothelial cells and promotes vascular growth and endothelial proliferation ( 13 ).…”