A Case of Trauma-Induced Arterial Thrombosis Mimicking Vasculitis

Abstract

Vasculitis mimickers are structural or pathologic entities that resemble the vasculitis clinical presentation and/or diagnostic findings. Their presence can be a conundrum, and physicians require careful assessment and adequate knowledge physicians when considering a diagnosis of vasculitis. Although they are considered mimickers, the therapeutic approach for most of them differs widely from that of vasculitis as high-dose steroids and potent immunosuppressive regimens are usually indicated in the latter. In fact, steroid therapy is contraindicated and is considered harmful in some of these mimickers (e.g. segmental arterial mediolysis). Therefore, it is important to distinguish them from vasculitis to prevent complications from immunosuppressive therapy. Hereby, we present a challenging case of a 64-year-old man who presented with acute gangrenous changes on his right fingers due to arterial thrombus after trauma resembling vasculitis.

Keywords: arterial; thrombosis; trauma; vasculitis; vasculitis mimickers.

Figure 1. Gangrene at the right middle finger

Figure 2. Computed tomography angiography (CTA) of the right-hand revealing thrombus formation (red arrow) and filling defect as compared to the aorta (Ao)

Figure 3. Segmental blood pressure and digital/brachial indexes

Figure 4. Right-hand Doppler blood flow waveform with normal triphasic waves in the first, fourth, and fifth digits and flat line in the second and third digits