Abstract

A 69-year-old previously healthy woman presented in extremis with multiorgan failure after 7 days of diarrhoea, abdominal discomfort, fatigue, and increasing pain and discoloration of her distal limbs. Initial assessment demonstrated a drowsy, obese woman with marked distal acrocyanosis and early gangrene ( Panels A–C ). Doppler ultrasound of her limbs showed absent flow signal in the distal left ulnar artery and in both the left distal posterior and anterior tibial arteries but normal flow elsewhere. There was …

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