This is the hand from a 40 year old male smoker (40 pack years). He also notes the same findings in the other extremities. The patient is not diabetic and negative for ANA, RF, anticentromere antibody, Scl-70, antiphospholipid antibodies. Complement is normal and there are no genetic causes for clot-formation. Transthoracic echocardiography shows a normal heart.Challenge: What's the diagnosis?
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Bue`rger disease?
Fingers
This is Buerger’s disease or Thromboangiitis obliterans, a nonatherosclerotic segmental inflammatory disease of the small and medium sized vessels seen in smokers. The pathology shows acute inflammatory thrombi in both arteries and veins of the distal extremities. Smoking cessation is the definitive therapy.
Sources: UpToDate; www.microsurgeon.org.
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