Vasculogenic paraplegia and impotence : A rare presentation of Buerger's disease

Buerger's disease is a non-atherosclerotic segmental inflammatory disease involving the small and medium-sized arteries, veins and nerves leading to claudication and ischemic changes. Long standing disease can rarely involve abdominal aorta, iliac arteries leading to rest pain, paraplegia and impotence. It holds strong association with tobacco use. We present the case of a 30 year old male bidi smoker who presented with paraplegia and impotence for few days preceeded by claudication pain and numbness. Pulses were reduced and absent in all four limbs. Arterial Doppler revealed reduced and absent velocities in all four limbs. Computed tomographic angiography showed narrowing and occlusion of infrarenal abdominal, internal iliac arteries and distal vessel bed. Considering Buerger's disease, patient was abstained from smoking, started on vasodilators, antiplatelet, statin and phosphodiesterase inhibitors. Surgical treatment was deferred. Abstinence from smoking definitely prevents disease progression. Prompt diagnosis and therapy can decrease chances of major amputations and disability.