An uncommon systemic arteritis--a case report

A 26-year-old male shortly after an acute respiratory disease was affected by a thrombophlebitis of the left leg. After a few days he had two syncopal attacks. Later on, a myocardial ischemia was diagnosed. Subsequently the patient began to complain of a bilateral claudication of the calves; after an attack of fever, the ischemia of the lower limbs worsened with recurring pain at rest. At the same time, in absence of any symptom, a myocardial ischemia occurred again and the presence of a thrombus was observed in the right atrium. After surgical removal of it, the ischemic troubles of the lower limbs once again began to worsen with the occurrence of bilateral gangrene of the feet. An amputation of both the legs was promptly performed at the level of the thighs. The histological examination of the arteries of the amputated legs showed segmental arteritis with partially recanalized thrombi of the popliteal, left femoral and tibioperoneal arteries. In the meantime, the titres for Coxsackie virus B2 and B6 were found slightly increased. One month later, the left radial pulse disappeared for a few days. The histopathological findings may relate this arteritis to a form of Buerger's disease even if a systemic thromboangiitis obliterans is not commonly accepted. In case that the acute respiratory infection represented the true onset of the sickness, it seems conceivable that the hypothesis of a viral infection gave raise to arteritis with morphological features recalling those of Buerger's disease.