Blue toe syndrome: A challenging diagnosis

“Blue toe syndrome” (BTS) refers to the acute onset of purple painful digits in the absence of evident trauma, cold-associated injury or disorders that induce generalized cyanosis. The term was used for the first time in 1976 by Komody, who underlined the vascular etiology of the disease and its possible diagnostic confirmation through angiography.[1,2] Indeed, BTS may occur from end-arterial occlusion, impaired venous outflow, and/or abnormal blood circulation. Peripheral microembolism with distal arterial occlusion is one of the most frequent underlying mechanisms of the disease and consists of disrupted material from ulcerated atheromatous plaques (atheromatous or cholesterol crystal emboli). The case described by us assumes significance because of an atypical clinical presentation of a peripheral embolism from an abdominal aortic aneurysm, hence necessitating a high index of suspicion to achieve the correct diagnosis..