Abstract
A 30-year-old man with previous diagnoses of Buerger disease (thromboangiitis obliterans; TAO), bronchial asthma, eosinophilia and a history of heavy smoking was referred to our hospital because of pain at resting in his bilateral fingers and dactyli. The resting pain was successfully treated conservatively after lumbar sympathectomy and thoracic sympathectomy, but his ulcer became worse. A granuloma in the right lung, bilateral coronary aneurysms and an edematous papule with pigmentation on the left leg were observed during follow-up. Allergic granulomatous angiitis was diagnosed based on the pathological findings of the edematous papule. However, this papule healed and his eosinophil level decreased to within the normal range following the administration of steroids and methotrexate, but the ulcer on his left leg became worse. A below-knee amputation was performed. However, the pathological findings did not reveal any eosinophilic infiltration in the crural artery. The pathological findings of the obstructive artery and skin lesions can be useful in patients with TAO and eosinophilia, when the diagnosis is in doubt. However, care must be taken to achieve a definitive diagnosis in patients with TAO-like symptoms and eosinophilia.
