Rickettsia is an intracellular pathogen that attaches to vascular endothelial cell membranes and its genome integrates into the
DNA of the host and thereby inhibits apoptosis of the endothelial cells. Rickettsia can infect the body following a flea/louse
bite. Rickettsia was suggested as one etiology of
Buerger's disease long ago. We report a patient with
Buerger's disease for whom a left below-knee
amputation was done. Twenty-five biopsies for
DNA extraction were obtained from the arteries, veins and microvasculature of the amputated limb. Three samples were positive for Rickettsia. The finding may explain the proliferation of endothelial cells in the pathology of
Buerger's disease, segmental nature of the disease, involving small- and medium-sized vessels, and the prevalence of
Buerger's disease among the low socioeconomic class of the society. Understanding the infectious etiology of
Buerger's disease would be invaluable, since early
antibiotic therapy or even vaccination might have prevented the limb loss in the current and other cases of
Buerger's disease. The authors suggest that
paraffin blocks of
Buerger's disease biopsies be investigated for
Rickettsia infection, focusing specifically on the area of endothelial cell proliferation for
DNA extraction. These results should be compared with other biopsies from a variety of other
peripheral vascular diseases.