A 74-year-old male presented with a 6-week history of rapidly progressive acral ischemia. Clinical examination revealed livid discoloration of his toes and fingertips. All peripheral pulses were palpable, and ankle brachial pressure indices were normal. Laboratory tests revealed thrombocytosis of 710,000/ul (normal range 140,000-320,000/|il), while red blood cells were within normal range and leukocytes were moderately elevated, indicating neutrophilia but otherwise normal differential blood count. Angiography showed obliteration of all digital arteries (top right panel). There were no proximal stenoses or plaques. A cardiac source of embolism was excluded by transesophageal echocardiography.
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