Progression of Buerger’s Disease in the Absence of Conventional Tobacco Exposure: A Case of Vape Associated Disease

Thromboangiitis Obliterans (TAO), or Buerger’s disease, is a nonatherosclerotic, inflammatory vasculopathy primarily affecting small and medium-sized vessels, most often in the distal extremities and is strongly associated with tobacco use. We present the case of a 29-year-old male with minimal prior cigarette smoking history who developed clinically apparent Buerger’s disease only following exclusive and heavy use of e-cigarette vaping. While cigarette, tobacco smoke is a well-established trigger, it is unclear what role nicotine or e-cigarette vape antigens may play in the role of Buerger’s disease. This case supports growing evidence that nicotine delivery systems, including e-cigarettes, may contribute to the pathogenesis or progression of Buerger’s disease. Clinicians should be aware of vaping as a potential risk factor and counsel patients with Buerger’s disease on the importance of complete smoking cessation, regardless of delivery method.