I read with interest the clinical observation of Marder and Mellinghoff1 regarding the possible association between Buerger disease and cocaine. Many epidemiological and toxicological studies are converging to demonstrate that Buerger disease may be related to arsenic intoxication. These interesting data are presented here.
Buerger disease is rare in Western countries but is the most prevalent vascular disease in Southeast Asia. Smoking is generally considered the principal cause. However, nonsmokers are sometimes also affected. In Western countries, the incidence of Buerger disease has been declining since 1947, but curiously not the rate of mortality due to cigarette smoking.2,3 In several Asian countries, such a decline in the incidence of Buerger disease has not occurred. In Taiwan, blackfoot disease (an endemic form of vascular thrombosis similar to Buerger disease) is related to arsenic poisoning from well water.4 The same public health problem is present in Bangladesh and in some areas of India where almost half of the population is at risk of arsenic intoxication.5,6 This could explain the high prevalence of Buerger disease in these regions. Toxicological and histological studies tend to confirm this pathological relationship.7
Noël B. Buerger Disease or Arsenic Intoxication? Arch Intern Med. 2001;161(7):1016. doi:
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