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Cannabis arteritis presenting with Raynaud’s and digital ulcerations: a case-based review of a controversial thromboangiitis obliterans-like condition

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Abstract

Thromboangiitis obliterans (TAO), or Buerger’s disease, is a non-atherosclerotic inflammatory disease of the small and medium-sized arteries, veins, and nerves of the legs and arms, strongly associated with the use of tobacco products in young adults. Cannabis arteritis (CA), an entity with similar clinical and pathological features, has been described in marijuana users as a subtype of TAO. Distinction between TAO and CA is challenging, given that most patients use tobacco and marijuana products concomitantly. Herein, we report the case of a male in his late forties who was referred to rheumatology with a 2-month history of hand swelling and bilateral painful digital ulcers with blue discoloration on his fingers and toes. The patient reported daily use of marijuana in blunt wraps and denied tobacco use. His laboratory work-up was negative for scleroderma and other connective tissue diseases. His angiogram confirmed the diagnosis of thromboangiitis obliterans, which was attributed to cannabis arteritis. The patient was started on aspirin and nifedipine daily and discontinued marijuana use. His symptoms resolved within 6 months and have not recurred for more than a year with continued avoidance of marijuana. Our case is one of the few that features primarily marijuana-driven CA and highlights the importance of not only considering marijuana use but also blunt wrap use in patients presenting with Raynaud’s phenomenon and ulcerations as cannabis use rises globally.

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References

  1. Olin JW (2018) Thromboangiitis obliterans: 110 years old and little progress made. J Am Heart Assoc 7(23):e011214. https://doi.org/10.1161/JAHA.118.011214

    Article  PubMed  PubMed Central  Google Scholar 

  2. Combemale P, Consort T, Denis-Thelis L, Estival JL, Dupin M, Kanitakis J (2005) Cannabis arteritis. Br J Dermatol 152(1):166–169. https://doi.org/10.1111/j.1365-2133.2005.06340.x

    Article  CAS  PubMed  Google Scholar 

  3. Grotenhermen F (2010) Cannabis-associated arteritis. Vasa 39(1):43–53. https://doi.org/10.1024/0301-1526/a000004

    Article  CAS  PubMed  Google Scholar 

  4. Santos RP, Resende CI, Vieira AP, Brito C (2017) Cannabis arteritis: ever more important to consider. BMJ Case Rep 2017. https://doi.org/10.1136/bcr-2016-219111

  5. Cottencin O, Karila L, Lambert M, Arveiller C, Benyamina A, Boissonas A, Goudemand M, Reynaud M (2010) Cannabis arteritis: review of the literature. J Addict Med 4(4):191–196. https://doi.org/10.1097/ADM.0b013e3181beb022

    Article  CAS  PubMed  Google Scholar 

  6. Mennis J, McKeon TP, Stahler GJ (2023) Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults. Addict Behav 138:107552. https://doi.org/10.1016/j.addbeh.2022.107552

    Article  PubMed  Google Scholar 

  7. Lazarides MK, Georgiadis GS, Papas TT, Nikolopoulos ES (2006) Diagnostic criteria and treatment of Buerger's disease: a review. Int J Low Extrem Wounds 5(2):89–95. https://doi.org/10.1177/1534734606288817

    Article  CAS  PubMed  Google Scholar 

  8. Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, Gordon T, Hardin JA, Kalden JR, Lahita RG, Maini RN, McDougal JS, Rothfield NF, Smeenk RJ, Takasaki Y, Wiik A, Wilson MR, Koziol JA (1997) Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum 40(9):1601–1611. https://doi.org/10.1002/art.1780400909

    Article  CAS  PubMed  Google Scholar 

  9. Olin JW, Young JR, Graor RA, Ruschhaupt WF, Bartholomew JR (1990) The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation. 82(5 Suppl):IV3–IV8

    CAS  PubMed  Google Scholar 

  10. Palaniappan V, Sadhasivamohan A, Karthikeyan K (2022) Raynaud's phenomenon and splinter hemorrhage: an early telltale sign of cannabis arteritis. Int J Dermatol 61(12):e480–e483. https://doi.org/10.1111/ijd.16143

    Article  PubMed  Google Scholar 

  11. Disdier P, Granel B, Serratrice J, Constans J, Michon-Pasturel U, Hachulla E, Conri C, Devulder B, Swiader L, Piquet P, Branchereau A, Jouglard J, Moulin G, Weiller PJ (2001) Cannabis arteritis revisited--ten new case reports. Angiology 52(1):1–5. https://doi.org/10.1177/000331970105200101

    Article  CAS  PubMed  Google Scholar 

  12. Zumbado M, Luzardo OP, Rodriguez-Hernandez A, Boada LD, Henriquez-Hernandez LA (2019) Differential exposure to 33 toxic elements through cigarette smoking, based on the type of tobacco and rolling paper used. Environ Res 169:368–376. https://doi.org/10.1016/j.envres.2018.11.021

    Article  CAS  PubMed  Google Scholar 

  13. Elam ERAV, Oliver AM (2022) Case report: blunt smoker denies tobacco use, delaying diagnosis. Rheumatologist https://www.the-rheumatologist.org/article/case-report-blunt-smoker-denies-tobacco-use-delaying-diagnosis/3/. Accessed 3 Feb 2022

  14. Adams MD, Earnhardt JT, Dewey WL, Harris LS (1976) Vasoconstrictor actions of delta8- and delta9-tetrahydrocannabinol in the rat. J Pharmacol Exp Ther 196(3):649–656

    CAS  PubMed  Google Scholar 

  15. El Omri N, Eljaoudi R, Mekouar F, Jira M, Sekkach Y, Amezyane T, Ghafir D (2017) Cannabis arteritis Pan Afr Med J 26:53. https://doi.org/10.11604/pamj.2017.26.53.11694

    Article  PubMed  Google Scholar 

  16. Banana Y, Bashir H, Boukabous S, Rezziki A, Benzirar A, El Mahi O (2022) Cannabis arteritis: a case report and brief review of the literature. Ann Med Surg (Lond) 76:103523. https://doi.org/10.1016/j.amsu.2022.103523

    Article  PubMed  Google Scholar 

  17. Thomas G, Kloner RA, Rezkalla S (2014) Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol 113(1):187–190. https://doi.org/10.1016/j.amjcard.2013.09.042

    Article  CAS  PubMed  Google Scholar 

  18. Peyrot I, Garsaud AM, Saint-Cyr I, Quitman O, Sanchez B, Quist D (2007) Cannabis arteritis: a new case report and a review of literature. J Eur Acad Dermatol Venereol 21(3):388–391. https://doi.org/10.1111/j.1468-3083.2006.01947.x

    Article  CAS  PubMed  Google Scholar 

  19. Raimbeau A, Pistorius MA, Goueffic Y, Connault J, Plissonneau-Duquene P, Maurel B, Reignier J, Asehnoune K, Artifoni M, Didier Q, Gautier G, Trochu JN, Rozec B, N'Gohou C, Durant C, Pottier P, Denis Le Seve J, Brebion N, Agard C, Espitia O (2021) Digital ischaemia aetiologies and mid-term follow-up: a cohort study of 323 patients. Medicine (Baltimore) 100(20):e25659. https://doi.org/10.1097/MD.0000000000025659

    Article  CAS  PubMed  Google Scholar 

  20. Piazza G, Creager MA (2010) Thromboangiitis obliterans. Circulation 121(16):1858–1861. https://doi.org/10.1161/CIRCULATIONAHA.110.942383

    Article  PubMed  PubMed Central  Google Scholar 

  21. Galyfos G, Kerasidis S, Kastrisios G, Giannakakis S, Sachmpazidis I, Anastasiadou C, Geropapas G, Papapetrou A, Papacharalampous G, Maltezos C (2017) Conservative treatment of patients with thromboangiitis obliterans or cannabis-associated arteritis presenting with critical lower limb ischaemia. Vasa 46(6):471–475. https://doi.org/10.1024/0301-1526/a000649

    Article  PubMed  Google Scholar 

  22. Dhadwal G, Kirchhof MG (2018) The risks and benefits of cannabis in the dermatology clinic. J Cutan Med Surg 22(2):194–199. https://doi.org/10.1177/1203475417738971

    Article  PubMed  Google Scholar 

  23. Wessler S, Ming SC, Gurewich V, Freiman DG (1960) A critical evaluation of thromboangitis obliterans. The case against Buerger's disease. N Engl J Med 262:1149–1160. https://doi.org/10.1056/NEJM196006092622301

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 609 Albany Street, Boston, MA, 02118, USA

    Eleni Pilitsi, Brooke Kennamer, Reina Gonzalez, Tania Phillips & Christina S. Lam

  2. Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, MA, USA

    Nicole Trepanowski

  3. Department of Rheumatology, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, MA, USA

    Marcin Trojanowski

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  1. Eleni Pilitsi
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Contributions

EP, RG, BK, and NT performed the literature search and EP, RG, BK, NT, TP, MT, and CL contributed substantially to the conception of the work and drafted and/or critically revised the work. All the authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Eleni Pilitsi.

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The patient gave their informed consent prior to their inclusion in the manuscript. The consent was approved by Boston Medical Center.

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This case was presented at the New England Dermatologic Society (NEDS) meeting in December 2022.

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ESM 1:

Video (Supplementary Material). Demonstration of a positive Allen’s test (DOCX 76 kb)

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Pilitsi, E., Kennamer, B., Trepanowski, N. et al. Cannabis arteritis presenting with Raynaud’s and digital ulcerations: a case-based review of a controversial thromboangiitis obliterans-like condition. Clin Rheumatol 42, 1981–1985 (2023). https://doi.org/10.1007/s10067-023-06603-x

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  • DOI: https://doi.org/10.1007/s10067-023-06603-x

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