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Editor's Correspondence
February 12, 2001

The Role of Cocaine in the Etiology of Buerger Disease Is Questionable—Reply

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

Arch Intern Med. 2001;161(3):486. doi:

In reply

The comments of Dr Bozkurt are noted, namely, that our patient does not fit the diagnostic criteria for Buerger disease according to the publication by Shionoya.1 Dr Bozkurt also points out that his review of hospital records of 258 such patients failed to reveal even a single case of cocaine addiction. We are pleased that our report has stimulated his efforts, since the proposal and hypothesis that we generated were meant to reevaluate the clinical entity and genesis of Buerger disease. Use of a table of criteria to diagnose a disease the distinction of which is questioned does not serve to contradict the question itself. Furthermore, we did not suggest that addiction to cocaine is a progenitor of the disease, but merely that the use of cocaine could predispose to vascular occlusive disease that could mimic Buerger disease. One cannot rule out temporal exposure to cocaine by failing to find a diagnosis of cocaine addiction in a patient's chart. We wholeheartedly agree with his final statement that "the significance of cocaine in the etiology of Buerger disease is at best controversial," since it is a novel concept, proposed more than 90 years after the original description.2

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