PMC6376526_01
Clinical photograph showing ray amputation of the second and third toes, with a poorly healed resultant wound.
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This ultimately resulted in a Ray amputation of the second and third toes due continued non-healing (Figure 1).
Clinical photographs showing the development (A) and progression (B) of digital ischaemia secondary to TAO.
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Unfortunately due to ongoing use of tobacco, symptoms recurred in the contralateral and dominant right hand affecting his index and middle finger tips (Figure 2A and B).
Histological appearance of biopsy tissue from the right index finger. (A) Epidermis with focal ulceration and a dermal acute on chronic inflammatory infiltrate surrounding adnexal structures; TAO is present with dermal fibrosis and background necrotic ulcer debris (40x magnification). (B) Fibrovascular tissue with chronic inflammation, lymphocytic arteritis and thrombosis (200x magnification).
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Histopathologic analysis showed evidence of chronic inflammation with lymphocytic arteritis and thrombosis, confirming a diagnosis of TAO (Figure 3).