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Buerger disease or thromboangiitis obliterans (TAO) is a thrombotic occlusive, non-atherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the extremities of the limbs, frequently requiring amputation. Cessation of tobacco use is the only known effective treatment, though preliminary results from the use of pharmacological therapy implicated in pathogenesis of TAO have demonstrated noticeable clinical improvement of patients. We report the case of a 35-year-old woman with active TAO, refractory to smoking cessation and conventional therapy, who exhibited a favorable clinical response to treatment with bosentan, an oral dual endothelin receptor antagonist, administered on a compassionate-use basis. Six months after starting bosentan therapy, the pain and trophic lesions in the patient's toes had completely disappeared. Bosentan was well tolerated, without any observed adverse reaction. The findings of this case report suggest that bosentan may be considered a therapeutic option for patients with active disease, despite quitting smoking, or for those who fail in absolute abstention from smoking.

Buerger disease or thromboangiitis obliterans (TAO) is a thrombotic occlusive, non-atherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the extremities of the limbs, frequently requiring amputation. Cessation of tobacco use is the only known effective treatment, though preliminary results from the use of pharmacological therapy implicated in pathogenesis of TAO have demonstrated noticeable clinical improvement of patients. We report the case of a 35-year-old woman with active TAO, refractory to smoking cessation and conventional therapy, who exhibited a favorable clinical response to treatment with bosentan, an oral dual endothelin receptor antagonist, administered on a compassionate-use basis. Six months after starting bosentan therapy, the pain and trophic lesions in the patient's toes had completely disappeared. Bosentan was well tolerated, without any observed adverse reaction. The findings of this case report suggest that bosentan may be considered a therapeutic option for patients with active disease, despite quitting smoking, or for those who fail in absolute abstention from smoking.

A case of a 38-year-old smoker male who had vasoconstriction and instep claudication of the right hand, is presented. After a year of evolution, he experienced the same alteration on the left foot. He was diagnosed as suffering from thromboangiitis obliterans, by means of angiography. After oral nifedipine treatment, combined with cessation of smoking, all symptoms and trophics regressed.

A case of congenital cutaneous candidiasis is reported. This is a rare infection of the new born, which is usually benign and autolimited unless it becomes generalized. Laboratory data which allows the differentiation of this disease from others clinically similars and the relevant literature are reviewed.

To the Editor.— Blistering distal dactylitis is a superficial infection of the anterior fat pad of the distal portion of the fingers, caused by group A β-hemolytic streptococci.1The disease has been described in children but, to our knowledge, no case in adults has been previously reported.1-5We herein report a case of blistering distal dactylitis in an adult fishmonger. Report of a Case.— A 35-year-old male fishmonger was referred to our office because of persistent purulent bullous lesions with an erythematous and edematous base. The locations of the lesions on the right hand were the volar fat pads (Fig 1) of the first, second, and third fingers and the dorsum of the fourth finger proximal interphalangeal joint (Fig 2). He complained of pain and functional disability without systemic symptoms. A thin, pale, purulent exudate was aspirated from these lesions. Group A β-hemolytic streptococci were isolated in culture.