In a recent issue of the ARCHIVES, I read with great interest the article by Marder and Mellinghoff.1 The hypothesis that cocaine could be the etiologic agent of Buerger disease seems questionable.
I strongly believe that the diagnosis of Buerger disease in this particular case is incorrect. Diagnostic criteria for Buerger disease proposed by Shionaya2 are (1) smoking habit; (2) onset of symptoms before age 50 years; (3) infrapopliteal arterial obstruction; (4) either upper limb involvement or phlebitis migrans; and (5) absence of atherosclerotic risk factors other than smoking. The clinical diagnosis is made when all 5 requirements are met.2 Arteriographic findings serve only in a supportive role, as mentioned by Marder and Mellinghoff.1
Bozkurt AK. The Role of Cocaine in the Etiology of Buerger Disease Is Questionable. Arch Intern Med. 2001;161(3):486. doi: