Symmetrical peripheral gangrene complicating staphylococcal toxic shock syndrome

Abstract

Sudden onset symmetrical peripheral gangrene (SPG) is a relatively uncommon clinical entity which was initially described in 1981 by Hutchison. It is defined as symmetric distal ischemic damage in two or more sites in the absence of major vascular occlusive disease [1, 2, 3]. It is a manifestation of many systemic disorders and accompanies infectious disease of various etiologies, shock, drugs and malignancy [1, 2, 3]. Toxic shock syndrome (TSS) is an acute life threatening inflammatory response characterized by fever, rash, hypotension, constitutional symptoms and multiorgan involvement [4, 5]. The disease first described in 1978, is typically associated with tampon use in healthy menstruating women. The disease also exists in men, neonates and non-menstruating women. TSS is a toxin mediated disease caused by coagulase - positive staphylococci (S aureus) and group A beta- hemolytic streptococci (S pyogenes) [4, 5]. We report a case of staphylococcal TSS, complicated by rapid onset SPG involving the toes and fingers.