Hand Ischemia Due to Arterial Thromboembolism in a Patient with Crohn’s Disease: A Case Report

Patients with inflammatory bowel disease (IBD) are at an increased risk of thromboembolic events due to chronic inflammatory state which include venous thromboembolism and rarely arterial thromboembolism (ATE). ATE involves thrombosis of the cerebral, splanchnic, carotid, coronary, aorta, renal and upper and lower extremity arteries. We describe a case of a 50-year-old female patient with crohn’s disease who developed ATE. She presented to the emergency department complaining of sudden pain in right hand with bluish discoloration of fingers associated with numbness over the C8 and T1 distribution. She was on mesalazine 3 g once daily for crohn’s disease. Examination of other systems was normal and there was no focal neurological deficit. Laboratory investigations were within normal limits. CT upper extremity angiogram showed abrupt cutoff of distal part of ulnar artery proximal to the tip of ulnar styloid. CT of thoracic aorta showed filling defect of the right brachiocephalic artery causing mild to moderate stenosis. She was managed conservatively with heparin, aspirin initially and discharged home on apixaban with complete resolution of the thrombus. To the best of our knowledge this is the first case of thromboembolism in the hand originating from the right brachiocephalic artery and obstructing the distal ulnar artery in a patient with crohn’s disease being reported and was successfully managed conservatively.