RARE CASE OF BUERGER'S DISEASE WITH ACUTE FULMINANT PROGRESSION TO DIGITAL ISCHAEMIA DESPITE AGGRESSIVE MEDICAL TREATMENT

Abstract

Objective: This case presents an unusual presentation of Buerger's disease. Design and method: We report a rare clinical presentation of TAO that may be of diagnostic clinical challenge at the onset. Results: Buerger's disease, also known as thromboangiitis obliterans (TAO), is a non-atherosclerotic, segmental inflammatory disease affecting small to medium-sized arteries and veins in the limbs. It is a rare disease seen mostly in young male smokers below 45 years of age. Disease course is typically gradual, progressing from claudication symptoms to rest pain eventually ischemic ulcers and gangrene. It is rare for patients to present with ischemic pain with rapid worsening in days. This is an interesting case of a 52-year-old male with no known past medical history who presented with digital ischemic rest pain. Initial investigations revealed mildly elevated inflammatory markers, while imaging studies showed thrombosis of bilateral radial and ulnar arteries, with dampened photoplethysmography. He was assessed to be unsuitable for endovascular intervention, consequently was treated medically with anticoagulants, statin, and prostaglandin analogue. He subsequently showed clinical improvement, with no compromise of his hand circulation, and was able to return to work. We report a rare clinical presentation of TAO that may be of diagnostic clinical challenge at the onset. Asians may be affected above the age of 50 years with acute fulminant progression to ischaemia and digital gangrene despite of aggressive medical treatment. Conclusions: Buerger's disease, or thromboangiitis obliterans (TAO), is a rare condition that presents a diagnostic challenge to many clinicians. Asians may be affected above the age of 50 years with acute fulminant progression to ischaemia and digital gangrene in spite of aggressive medical treatment.