Department of Psychiatry, Dalhousie University, Medical School, Halifax, Canada.
The College of Physicians and Surgeons of Nova Scotia, Halifax, Canada.
J Med Case Rep. 2023 Jan 30;17(1):40. doi: 10.1186/s13256-022-03694-z.
Peripheral manifestations secondary to progressive vascular occlusions are characteristic of the rare condition termed thromboangiitis obliternas (TAO) or Buerger's disease. The central manifestations of this disease are however poorly characterized, particularly those of psychiatric nature, and their prevalence is largely unknown. Speculations have been made around the polymorphic nature and triggers of observed psychopathology in TAO; much however remains to be unraveled in this area.
We present the case of a 33-year-old Caucasian male who developed first episode of psychosis at the age of 29 years. There was no history of previous mental illness either in the patient, or in any of his family members. He had been a long- term heavy smoker and was experiencing progressive lower limb claudication since the age of 22 years; however, all inflammatory, autoimmune and atherosclerotic markers were negative. His psychosis was characterized by retention of a warm affect, and despite some amelioration, was generally resistant to a fair trial of several anti-psychotic medications including Clozapine.
The pathophysiology of psychosis secondary to Buerger's is not yet well characterized which adds to the complexity of managing these cases. Recognizing that cerebral manifestations of this disease may evolve several years after the onset of peripheral thromboangiitic features is important for following the natural history and considering measures that may reduce the burden of illness.
继发于进行性血管闭塞的外周表现是一种罕见疾病——血栓闭塞性脉管炎（TAO）或伯格氏病的特征。然而，这种疾病的中枢表现特征描述不足，特别是那些精神方面的表现，其流行程度也知之甚少。人们对 TAO 中观察到的精神病理学的多态性和诱因进行了推测；但在这一领域仍有许多未解之谜。
我们介绍了一位 33 岁的白人男性患者，他在 29 岁时首次出现精神病发作。患者或其任何家庭成员均无先前精神疾病史。他长期大量吸烟，从 22 岁开始出现下肢间歇性跛行；然而，所有炎症、自身免疫和动脉粥样硬化标志物均为阴性。他的精神病表现为保留温暖的情绪，尽管有所改善，但对几种抗精神病药物（包括氯氮平）的合理试验通常仍然耐药。
伯格氏病继发精神病的病理生理学尚未得到很好的描述，这增加了管理这些病例的复杂性。认识到这种疾病的中枢表现可能在周围血栓闭塞性特征出现几年后才会出现，这对于随访自然病程和考虑可能减轻疾病负担的措施非常重要。
