Case 133: Raynaud's Disease, Nicotine Addiction and Generalized Arteriosclerosis in Traveling Woman

Referred by a friend, this 51 year old white woman presented on September 7th, 1990 for evaluation of Raynaud's disease. A regular smoker, she first had problems with her hands leading to a cervical sympathectomy in 1964. Beginning in March of 1990, she suffered from numbness of the right leg, nocturnal rest pain and less than one block claudication; she could walk the one block limping. She had an ulcer on her second toe and a paronychia on her first toe( first picture). Her physical findings included, besides the toe ulcers, ulcers of her right first and third fingertips and scarring of various other fingers. Although said to have Raynaud's disease, it was obvious that she had significant occlusive arterial disease and a nicotine addiction suggesting Buerger's disease. She was started on the boot for her arteriosclerosis and her foot healed (second photograph). Her angina, however, did not discourage her from continuing to smoke. She was contacted four years later for follow-up for our boot reports. In the interval, she had had two coronary angioplasties, a bypass of her other leg and two fingers amputated. She then became a non-smoker. The right leg, which we had pumped in 1990, had required no further therapy and was doing well.

Painful big toe paronychia and second toe ulcer

Both of her lesions healed with booting in spite of her smoking.

Comments: Even though her right leg did well with booting, she did not return for treatment of the problems in her hands and other leg. The freedom our patients have in seeking care in multiple institutions and among multiple doctors in the same institution makes small studies outside of the clinical research center quite difficult.