A 59-year-old male, chronic smoker presented with pain and burning sensation in the 3rd toe of the right foot of one-year duration. He had similar complaints 3 years prior, in the 4th and 5th toes which resulted in auto-amputation. A diagnosis of thromboangiitis obliterans was made and the patient was treated with Inj. xanthinol nicotinate IV 3000mg, 4500mg and 6000mg respectively in 250ml of normal saline over three consecutive days. On day 2, patient developed itchy vesicles and edema on the left forearm at the site of IV cannula. Diffuse erythema of face, trunk and proximal extremities was also seen. Considering a possibility of acute drug reaction to xanthinol nicotinate, patient was advised to stop the injection and was treated symptomatically with anti-histaminics and topical steroids.