Clinical and Experimenlat Dermalotogy 1990; 15: 46-49.

Thromboangiitis obliterans (Burger's disease) in a woman a case report and review of the literature A.N.ABDULLAH AND K.KECZKES

Hull Royal Infirmary, Anlaby Road, Hull HV3 1]Z, UK

Accepted for puhlication IHJune 1989

Summary We report the case of a 43-year-old woman, a longstanding heavy cigarette smoker., who developed Burger's disease, leading to mid-thigh amputation of her left leg. After she gave up smoking her disease was arrested but Raynaud's phenomenon continues to affect her hands and right foot. In reviewing the literature, we found only 25 previous well-documented cases of Burger's disease occurring in females that would satisfy clinical, angiographic and histological criteria to make this diagnosis probable. Thromboangiitis obliterans (also known as Burger's disease) is a non-athero.sclerotic, segmental, inflammatory, occlusive vascular disease of unknown aetiology, occurring predominantly in male, heavy cigarette smokers under the age of 50 years. The disease involves principally the medium-sized and small arteries and veins of the upper and lower extremities and, rarely, cerebral and visceral blood vessels.' It was first described by Felix von Winiwarter, a Viennese surgeon, in 1879,' but became better known in the English literature when Leo Burger, another Viennese, described it in 1908.' Thromboangiitis obliterans has a world-wide distribution, but is more common in India and Eastern Europe than in the Western hemisphere. Originally, it was thought to occur predominantly in Jews but this proved to be a misconception. Up to 1973 eight of the reported 22 cases occurred in women.^ Since 1973 we have found a further 17 cases in the literature.'' '' We would like to report another female patient; to our knowledge, the first one from Britain with this rare disease.

South Africa, where she lived in the Transvaal for 15 years. Her problems started in June 1983, whilst still living in South Africa, with a red, painful lesion on the back of the left foot accompanied by swelling of the left foot. She thought it was an insect bite but the lesion persisted and was getting gradually worse and extremely painful. She gave a long history of blanching and bluish discoloration of the fingers and toes on exposure to cold. She had jaundice at the age of 14 years and admitted to having smoked 20-30 cigarettes daily for many years. She had had eight miscarriages in the past, developed toxoplasmosis 8 years before the present problem started and had an appendicectomy 10 years ago. She was never on the contraceptive pill. She is a tall, thin woman of light complexion. On routine physical examination, there was a black eschar on the back of the left foot which was red and swollen. The lesion measured about 6 cm in diameter. There was also a back eschar on the tip of the left big toe (Figs 1 and 2) and mottled, bluish discoloration of the skin affecting the toes, feet and back of the left foot and ankle. The dorsalis pedis and posterior tibial pulses were absent on the left foot. There was no lymphadenopathy behind the left knee or in the region of the left groin. Her radial pulse rate was

Case report A 37-year-old English woman was seen at the Dermatological Clinic in February 1984, having come back from Correspondence: Dr K. Kec2kes, Hull Royal Infirmary, Aniaby Road, Hull IIU3 2JZ N. Humberside, UK.


F i g u r e 1 . L I c c r a l c d I c s m n w i t h b k i c k f s c h i i r o n I I I K I

Thromboangiitis obliterans (Bürger's disease) in a woman--a case report and review of the literature.

We report the case of a 43-year-old woman, a longstanding heavy cigarette smoker, who developed Bürger's disease, leading to mid-thigh amputation of h...
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