Paraneoplastic Arterial Thrombosis Masquerading as Buerger’s Disease: A Case Report and Literature Review

Abstract

Background: Arterial occlusion as the sentinel manifestation of an occult malignancy is an infrequent but critical clinical occurrence. This case report describes an atypical presentation of acute limb ischemia in a non-smoker, initially mimicking Buerger’s disease (Thromboangiitis Obliterans).

Case Presentation: A 46-year-old male fisher man, a lifelong non-smoker, presented with Rutherford Class IIb acute limb Ischemia of the left foot. Physical examination revealed the "5Ps" (pain, pallor, pulselessness, paresthesia, and paralysis) with absent distal pulses. Although the patient's age and distal arterial involvement initially suggested Thromboangiitis Obliterans (Buerger’s disease), the absence of tobacco exposure—a mandatory Shionoya diagnostic criterion—prompted a systemic search for malignancy.

Contrast-enhanced computed tomography (CECT) revealed a 4.2 cm pancreatic body tumor with multiple hepatic metastases. Biopsy confirmed Stage IV pancreatic adenocarcinoma. Despite anticoagulation with low-molecular-weight heparin, the prognosis remained poor due to the advanced stage of the malignancy.

Conclusion: This case underscores the necessity of malignancy screening in patients with unexplained arterial occlusion who lack traditional vascular risk factors. It advocates for the inclusion of paraneoplastic syndromes in the differential diagnosis of atypical distal vasculopathy.