Psychiatric sequelae of thromboangiitis obliterans: a case report and review of the literature

Abstract

Background: Peripheral manifestations secondary to progressive vascular occlusions are characteristic of the rare condition termed thromboangiitis obliternas (TAO) or Buerger's disease. The central manifestations of this disease are however poorly characterized, particularly those of psychiatric nature, and their prevalence is largely unknown. Speculations have been made around the polymorphic nature and triggers of observed psychopathology in TAO; much however remains to be unraveled in this area.

Case presentation: We present the case of a 33-year-old Caucasian male who developed first episode of psychosis at the age of 29 years. There was no history of previous mental illness either in the patient, or in any of his family members. He had been a long- term heavy smoker and was experiencing progressive lower limb claudication since the age of 22 years; however, all inflammatory, autoimmune and atherosclerotic markers were negative. His psychosis was characterized by retention of a warm affect, and despite some amelioration, was generally resistant to a fair trial of several anti-psychotic medications including Clozapine.

Conclusion: The pathophysiology of psychosis secondary to Buerger's is not yet well characterized which adds to the complexity of managing these cases. Recognizing that cerebral manifestations of this disease may evolve several years after the onset of peripheral thromboangiitic features is important for following the natural history and considering measures that may reduce the burden of illness.

Keywords: Buerger's disease and schizophrenia-like-psychosis; Case report; Thromboangiitis obliterans inducing psychosis; Treatment resistant organic psychosis.

Fig. 1

A Abdominal CT Scan Demonstrating Patent Abdominal Aorta. B Patent aortic bifurcation but right superficial femoral artery (SFA) was occluded along with the venous graft connecting the distal SFA to the tibioperoneal trunk. C Successful subintimal recanalization and angioplasty was performed of the right distal posterior tibial artery occlusion as well as the proximal peroneal artery occlusion. D MRI brain scan demonstrating a few tiny left frontal subcortical and periventricular T2/FLAIR hyperintense nonspecific foci

Fig. 2

Pathogenesis of Buerger’s Disease (thromboangiitis obliterans). Reproduced with Permission from Dr. Cooper and Annals of the New York Academy of Sciences [9], (Order License ID 1311888-1, ISSN 1749-6632)