Endocrine Abstracts

Introduction: Leo Burger’s thromboangiitis obliterans ‘TALB’ is a rare inflammatory, segmental and occlusive disease affecting small and medium-sized arteries and the veins of the extremities of the limbs. It is more common in males and its major aggravating factor is smoking.

Observation: We present the case of a 66-year-old patient with a history of chronic smoking at a rate of 25 packs per year, known type 2 diabetic for 10 years, well balanced under hygieno-dietetic measures alone (HBA1C = 6.5 %) without degenerative complications and who consults for necrosis of the right big toe associated with plantar claudication and right plantar erythema. Clinical examination revealed acute distal ischemia of the right lower limb with abolition of the distal pulses on the right and gangrene in the right big toe. The inflammatory, lipid and hemostasis assessment as well as the immunological assessment and viral serologies (HIV, HCV, and HVB) are negative. Vascular imaging shows an occlusion of the right superior popliteal artery. The patient underwent a femoropopliteal bypass with strict discharge and local care combining cleanings and excision of necrotic tumor tissue. Amputation of the right big toe is indicated. Psychological and medical support is in place to obtain smoking cessation.

Discussion and conclusion: The diagnosis of TALB is a diagnosis of elimination evoked in the absence of specific markers and identified etiological factors and which must be considered in the well-balanced diabetic patient with chronic smoking hence the interest of a overall burden of diabetics aimed both at balancing diabetes but also at correcting other cardiovascular risk factors, in particular smoking cessation, as is the case for our patient.