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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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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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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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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).

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