Abstract
Thromboangiitis obliterans (TAO) is an autoimmune vasculitis that typically presents in male smokers between the ages of 25 and 40. Although TAO primarily affects medium-sized blood vessels, it can also infiltrate small blood vessels as well as nerves and veins. The inflammation can cause segmental thrombosing and occlusion of the blood vessels leading to gangrene and eventual amputations. This case presents a unique sequela of TAO, in which a 28-year-old male with a chronic tobacco smoking history was diagnosed with TAO after presenting with pain and discoloration in his foot, in addition to superimposed osteomyelitis. This case serves to remind emergency clinicians, internal medicine physicians, general practitioners, and infectious disease specialists of the TAO differential in patients presenting with pain and discoloration in the feet, as well as the importance of working up the patient for any superimposed infections.
Highlights
Thromboangiitis obliterans (TAO) is an autoimmune vasculitis that typically presents in male smokers between the ages of 25 and 40
The inflammation can cause segmental thrombosing and occlusion of the blood vessels leading to gangrene and eventual amputations. This case presents a unique sequela of TAO, in which a 28-year-old male with a chronic tobacco smoking history was diagnosed with TAO after presenting with pain and discoloration in his foot, in addition to superimposed osteomyelitis
Thromboangiitis obliterans (TAO), otherwise known as Buerger’s disease, is a rare, locally aggressive, vascular occlusive disease of the small and medium vessels that is highly associated with smoking and tobacco usage
Summary
Thromboangiitis obliterans (TAO), otherwise known as Buerger’s disease, is a rare, locally aggressive, vascular occlusive disease of the small and medium vessels that is highly associated with smoking and tobacco usage. A bilateral lower extremity arterial study showed concordant pulse volume recording waveforms This technique is used to calculate blood volume changes in legs that are displayed as a waveform. The patient displayed minimal changes in volume signifying occlusion to blood flow He had a bilateral lower extremity angiogram that showed dampened monophasic flow in the lower legs bilaterally with occlusion of all three tibial arteries at the level of the mid-calf with multiple corkscrew collaterals extending toward the left foot. The patient was placed on Tylenol, ketorolac, and Percocet as needed for pain management He was counseled on smoking cessation and the relevant association between tobacco use and TAO. The patient was able to ambulate without complaints; he maintained his smoking habits and was further counseled on smoking cessation
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