[Digital necrosis in a patient with anorexia nervosa. Association of vasculopathy and radial artery injury].
BACKGROUND
Patients with anorexia nervosa can develop distal vasculopathy sometimes leading to severe Raynaud's phenomenon or acrocyanosis. We report a cas of anorexia nervosa-related vasculopathy associated with iatrogenic injury to the radial artery that led to digital necrosis.


METHODS
An 18-year-old woman, with a history of severe anorexia nervosa of 5 years duration and who acknowledged regular use of tobacco and cannabis, was hospitalized for necrosis of the left index and thumb that had occurred shortly after left radial artery puncture for blood gas analysis. Acrocyanosis of the 4 limbs had been present since the onset of anorexia nervosa. Arteriography of the upper limbs showed major spasm of the left radial and cubital arteries and thromboses in the left interdigital arteries of the left index and thumb. The distal portions of the arteries were then on the left and on the right. The nectrotic lesions healed after intravenous administration of ilomedine and interruption of tobacco and cannabis. Acrocyanosis of the four limbs persisted.


CONCLUSIONS
We report a case of digital necrosis occurring after arterial puncture for blood gas analysis in a patient with a vascular bed weakened by tobacco and cannabis intoxication but also by anorexia nervosa-related vasculopathy. This observation underlines the potentially dangerous nature of invasive intravascular procedures in this context. Indications for vessel puncture must be assessed with prudence.
Launay
D
D
Service de Médecine interne A, Hôpital Claude Huriez, CHRU de Lille. dlaunay@caramail.com
Queyrel
V
V
Hatron
P Y
PY
Michon-Pasturel
U
U
Hachulla
E
E
Devulder
B
B
D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications*; D001784:Blood Gas Analysis; D001800:Blood Specimen Collection / Q000009:adverse effects*; D005260:Female; D005385:Fingers / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D009336:Necrosis; D011677:Punctures / Q000009:adverse effects*; D017534:Radial Artery / Q000293:injuries*; D011928:Raynaud Disease / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors