George Nune, MD

A 46‐year‐old man with a history of heavy marijuana use for 30 years presented to the emergency room with 1 month of progressively worsening distal extremity pain and numbness that had developed into necrosis at the tips of his fingers (Figure 1A, arrows). The patient did not have other systemic symptoms. Transthoracic echocardiogram was normal. An evaluation for hypercoagulable disorders, blood cultures, C‐ANCA, cryoglobulins, Hepatitis C serologies, and human immunodeficiency virus (HIV) serologies were all negative. Erythrocyte sedimentation rate was within normal limits. An arteriogram of the hands showed distal subsegmental obliteration of digital arteries (Figure 1B, arrows), which was consistent with thromboangiitis obliterans (Buerger's Disease). While the patient rarely consumed tobacco, he reported smoking up to 10 marijuana cigarettes daily and a diagnosis of cannabis arteritis was made. The patient was encouraged to discontinue smoking and at follow‐up he had marked improvement in symptoms with abstinence from marijuana.

Figure 1

A 46‐year‐old man with a history of heavy marijuana use for 30 years presented to the emergency room with 1 month of progressively worsening distal extremity pain and numbness that had developed into necrosis at the tips of his fingers (Figure 1A, arrows). The patient did not have other systemic symptoms. Transthoracic echocardiogram was normal. An evaluation for hypercoagulable disorders, blood cultures, C‐ANCA, cryoglobulins, Hepatitis C serologies, and human immunodeficiency virus (HIV) serologies were all negative. Erythrocyte sedimentation rate was within normal limits. An arteriogram of the hands showed distal subsegmental obliteration of digital arteries (Figure 1B, arrows), which was consistent with thromboangiitis obliterans (Buerger's Disease). While the patient rarely consumed tobacco, he reported smoking up to 10 marijuana cigarettes daily and a diagnosis of cannabis arteritis was made. The patient was encouraged to discontinue smoking and at follow‐up he had marked improvement in symptoms with abstinence from marijuana.

Figure 1

A 46‐year‐old man with a history of heavy marijuana use for 30 years presented to the emergency room with 1 month of progressively worsening distal extremity pain and numbness that had developed into necrosis at the tips of his fingers (Figure 1A, arrows). The patient did not have other systemic symptoms. Transthoracic echocardiogram was normal. An evaluation for hypercoagulable disorders, blood cultures, C‐ANCA, cryoglobulins, Hepatitis C serologies, and human immunodeficiency virus (HIV) serologies were all negative. Erythrocyte sedimentation rate was within normal limits. An arteriogram of the hands showed distal subsegmental obliteration of digital arteries (Figure 1B, arrows), which was consistent with thromboangiitis obliterans (Buerger's Disease). While the patient rarely consumed tobacco, he reported smoking up to 10 marijuana cigarettes daily and a diagnosis of cannabis arteritis was made. The patient was encouraged to discontinue smoking and at follow‐up he had marked improvement in symptoms with abstinence from marijuana.

Figure 1