Epidemics of vascular disease caused by toxins and infectious agents affect
ing both humans and animals have been common in history. Examples of agents
implicated include anorexients, ergotamine, mercury, arsenic, vinyl chlori
de, thorotrast, plant alkaloids, nitrites, toxic oil, tryptophan and bacter
ial, viral and parasitic infections. A major characteristic of these disord
ers is endothelial dysfunction, which may manifest itself in vasospastic di
sorders, sclerodermiform skin lesions, fibrosis, osteolytic lesions, polyne
uropathy and portal and pulmonary hypertension. Angiosarcoma may also be a
late outcome. These diseases are more common than is generally appreciated.
The aetiology is usually multifactorial. This and other factors contribute
to delayed recognition.