Acute acral ischemia in all fingers probably due to an infection with borrelias

Acute interruption of circulation in the distal fingers can be both express ion of an embolic event as well as the first manifestation of a vasculitis or collagenosis. The search for its cause is frequently difficult. In many cases a specialized analysis of the coagulation system as well as diagnosti cs such as ultrasound scan of the heart or a systematic antibody scanning d o not reveal the origin of an embolus or the underlying disorder On the basis of a case-report we would like to focus on a possible context between an infection of Borrelias stage III and conservative deterioration of peripheral arterial perfusion in the fingers. Besides Jo-1- and positive sceleton-muscle-antibodies there were no serological and clinical indicati ons for an autoimmune disease. It was possible to avoid acral necrosis by m eans of an antibiotic, immunosuppressive and rheological therapeutic concep t. We recommend to control the borellia-antibody-level in cases of obscure thr eatening peripheral necrosis caused by arterial perfusion stop.