Chronic Bilateral Distal Radial and Ulnar Artery Occlusion Presenting as Peripheral Neuropathy in a Young Adult

BACKGROUND: Distal radial and ulnar artery occlusion is a rare condition, especially in the absence of trauma, invasive procedures, vasculitis, or embolic events, and it may mimic neuropathic symptoms, leading to delayed diagnosis. CASE SUMMARY: A 32-year-old woman with uncontrolled hypertension, hypercholesterolemia, and obesity presented with 6 months of intermittent pain, tingling, and discoloration in both hands, which had worsened over the past 2 weeks. Examination showed cold extremities, diminished radial pulses, prolonged capillary refill, oxygen saturation below 94% in the fingers, and skin changes; results on the Michigan Neuropathy Screening Instrument and Neuropathy Disability Score indicated mild neuropathy. Duplex ultrasonography confirmed bilateral narrowing of the distal radial and ulnar arteries. Treatment with nifedipine, aspirin, atorvastatin, captopril, and vitamin B complex, as well as lifestyle modification counseling resulted in improvement within 3 days, including fingertip oxygen saturation rising to 95% and improved arterial lumen diameters. DISCUSSION: This case demonstrates that upper limb peripheral artery disease may present as neuropathy, underscoring the importance of clinical assessment and duplex ultrasonography for early detection and effective conservative management. Management focuses on risk-factor modification, pharmacological therapy (antiplatelets, statins, antihypertensive agents), and supportive neuropathic care, while revascularization is reserved for refractory or limb-threatening cases. TAKE-HOME MESSAGES: Chronic bilateral distal radial and ulnar artery occlusion is a rare peripheral artery disease that may cause neuropathy owing to hypoperfusion, inflammation, and microvascular dysfunction. Diagnosis relies on clinical evaluation and duplex ultrasonography. Management centers on conservative therapy, including risk-factor control, antiplatelets, statins, and neuropathy treatment.