Shima Natsuki, Akiyama Yoichiro, Yamamoto Shotaro, Kokuzawa Ayako, Nagatani Katsuya, Iwamoto Masahiro, Matsubara Daisuke, Kawai Shigeo, Sato Kojiro, Minota Seiji
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Japan.
Department of Rheumatology, Tochigi Medical Center Shimotsuga, Japan.
Intern Med. 2020 Feb 1;59(3):439-443. doi: 10.2169/internalmedicine.3372-19. Epub 2019 Oct 7.
A 48-year-old woman with severe pain and numbness of her right leg and foot was admitted to our hospital. She had never smoked and had little exposure to passive smoking. Initially, polyarteritis nodosa with anti-phospholipid antibodies was considered. Combination therapy with methylprednisolone pulse therapy, intravenous cyclophosphamide pulse therapy, vasodilators, antiplatelet agents, and anticoagulants was not effective. Vasculopathy was progressive, and she presented with gangrene of the toes. She required amputation of her right leg. The pathological findings of the amputated leg revealed thromboangiitis obliterans (TAO). TAO should be considered even in non-smoking women. Non-response to immunosuppressant and anticoagulant therapies may be a clue to the diagnosis of TAO.
一名48岁女性因右下肢和足部剧痛及麻木入院。她从不吸烟，很少接触被动吸烟。最初考虑为伴有抗磷脂抗体的结节性多动脉炎。甲基强的松龙脉冲疗法、静脉注射环磷酰胺脉冲疗法、血管扩张剂、抗血小板药物和抗凝剂的联合治疗无效。血管病变呈进行性发展，她出现了脚趾坏疽。她需要截肢右腿。截肢腿部的病理检查结果显示为血栓闭塞性脉管炎（TAO）。即使在不吸烟的女性中也应考虑TAO。对免疫抑制剂和抗凝治疗无反应可能是诊断TAO的线索。
