Etiology of ‘blue toe’ syndrome: Emboli versus warfarin therapy. Report of a case

‘Blue toe syndrome’ presents as a cyanotic toe caused by fibrino-platelet micro-emboli occlusion of the small digital arteries, with palpable pedal pulses originating from a proximal atheromatous source (cardiac, aortic, femoral or popliteal aneurysm). We report a case in a 43-year-old woman with a history of hypertension and diabetes. She was taking warfarin for extensive right deep-vein thrombosis 6 months before her current admission. She presented with sudden onset of severe pain, parasthaesia and bluish discolouration of the right big, second and third toes, in spite of palpable distal pulses. Computerized tomography angiography revealed an atheromatous plaque causing 70% stenosis of the infra-renal aorta. We therefore performed aortotomy, thrombectomy and endartectomy. Blue toe syndrome is of clinical importance in etiology, diagnosis and treatment. Our case had blue toe syndrome despite anticoagulant therapy.