Key result
Smoking cessation, bilateral thoracoscopic sympathectomy, and folate supplementation improve symptoms and heal digital infarction.
Case Report (n=1)
Bilateral video-assisted thoracoscopic sympathectomies combined with smoking cessation and folate supplementation successfully treated painful digital infarction in a patient with Buerger's disease.
May support multimodal therapy in refractory Buerger's disease; hypothesis-generating and requires prospective trials before wider adoption.
A 40-year-old male smoker presented with a 3-week history of painful digital infarction involving the hands. Histology was unhelpful, showing lichen simplex chronicus. A provisional diagnosis of a vasculitic disease was made. Treatment included aspirin, azathioprine, iloprost, methylprednisolone, nifedipine and prednisolone. After failure of these treatments an alternative clinical diagnosis of Buerger's disease was made. Treatment was to advise the patient of the importance of continuing to abstain from smoking, to perform bilateral video-assisted thoracoscopic sympathectomies and to commence folate supplementation. This led to marked improvement of his symptoms and healing of the digital infarction.
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Foley et al. (2008) conducted a case report in Painful digital infarction / Buerger's disease (n=1). Smoking cessation, bilateral video-assisted thoracoscopic sympathectomies, and folate supplementation was evaluated on Symptom improvement and healing of digital infarction. Smoking cessation, bilateral video-assisted thoracoscopic sympathectomies, and folate supplementation led to marked improvement of symptoms and healing of digital infarction.
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