A rare case of arteriosclerosis obliterans without prominent risk factors complicated by idiopathic thrombocytopenic purpura. A case report.
An eighty-four-year-old man was admitted to the hospital because of pain at rest in the lower extremities. On physical examination, trophic changes of the skin and petechiae in the limbs were observed. Computed tomographic scan of the abdomen showed focal renal infarctions and calcification of the descending aorta. Moreover, radionuclide imaging of the arterial system revealed complete obstructions of the two right iliac arteries and the left external iliac artery, where collateral flows were observed. Laboratory examination showed a severe thrombocytopenia caused by immunoglobulin G (IgG)-type autoantibody against platelets. He was diagnosed as having arteriosclerosis obliterans complicated by idiopathic thrombocytopenic purpura, although no known risk factors promoting atherosclerosis other than age were evident. In such a case with hemorrhagic diathesis, a hemorheologic agent and the vasodilator prostaglandin could confer advantages in relieving and controlling the ischemic leg pain without hemorrhagic complications. Moreover, small doses of the initial prednisolone therapy for ITP might also be recommended to avoid thrombus formations in the atherosclerotic lesions.
Yamagishi
S
S
Department of Internal Medicine, Kanazawa Municipal Hospital, Kanazawa, Japan.
Ohta
M
M
Segawa
C
C
Abe
T
T
Sawada
T
T
D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000627:therapeutic use; D001162:Arteriosclerosis Obliterans / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D018450:Disease Progression; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D012307:Risk Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
D005938:Glucocorticoids; D014665:Vasodilator Agents; D011239:Prednisolone; D000527:Alprostadil