Reference as: Raschke RA. Painful necrotic fingers. Southwest J Pulm Crit Care 2010;1:8-9. (Click here for PDF version)
A 38-year-old woman, an active smoker, presents with complaints of finger pain and changes in skin color. A photograph of the patients fingers is shown above. This photo was taken in 1989, before the hospital instituted a no smoking policy. Prior to that time, patients were allowed to smoke in their hospital rooms.
Catheter angiography was performed and showed a corkscrew configuration of the small arteries of the hand and fingers. Evaluation for connective tissue diseases was negative.
What is your diagnosis?
Answer: Buerger's disease (thombangitis obliterans).
Discussion
First described by Leo Buerger in 1908, Buerger’s disease (thrombangitis obliterans) is characterized by an inflammatory thrombosis of small to medium-sized arteries and veins, predominantly affecting the distal extremities. The disorder is unusual in women, but is extremely strongly associated with use of tobacco products. The only proven therapy for Buerger's disease is smoking cessation.
Robert A. Raschke, M.D.