Paradisebirds Anna And Nara 16 S

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Paradisebirds Anna And Nara 16 S

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Introduction: Cannabis is the psychoactive substance most consumed by young people. The thromboangiitis obliterans is an inflammatory, segmental and non-atherosclerotic disease, which most commonly affects the arteries and veins of small and medium calibers of the extremities. It is most frequent in men and is strongly associated with tobacco use. The cessation of smoking is important to decrease the risk of amputation. It has also been reported in marijuana users (Cannabis Arteritis).

Case report: Woman, 33 years old, former smoker of 20 packs-year and a regular marijuana user. Deny use of other illicit drugs. She presents ischemic lesions of 10 years evolution in extremities, with a previous history of amputation of her second left pododactyl. In another hospitalization she had negative research for thrombophilia and she stopped smoking because of the thromboangiitis obliterans hypothesis, however the lesions continued to progress. She was admitted for investigation of the lesions in September 2017, when she was submitted to an angio tomography and arterial Doppler of the limbs, without alterations. ANA, ANCA, VDRL, RF and serologies for HIV and hepatitis B and C were negative and there was no monoclonal peak into electrophoresis of serum proteins. Arteriography of the lower limbs showed obstruction of the left anterior tibial artery in the middle and distal thirds and of the microcirculation of the ipsilateral foot. Because of the evolution of the lesions, treatment with alprostadil, acetylsalicylic acid, cilostazol and calcium channel blocker was initiated. During the hospitalization period, the lesions showed improvement, with complete healing. After 3 months of discharge, the patient returned to a routine visit with signs of digital ischemia and with the reappearance of the ulcers, when she admitted having returned the use of marijuana and noticed its correlation with the lesions. We kept the same treatment of the first hospitalization and referred to psychology and psychiatry services for assistance in the treatment of drug withdrawal. The lesions regressed again, reinforcing the suspicion of association with the use of Cannabis.

Comments: Despite currently available reviews do not suggest the use of Cannabis as a cause of arteritis due to the concomitant use of tobacco in most patients, our patient presented worsening of the lesions after cessation of smoking and important improvement after the suspension of marijuana, strengthening the hypothesis of this association.

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