Abstract

Introduction: Symmetrical peripheral gangrene (SPG, or peripheral symmetrical gangrene, PSG) is defined as acute onset of symmetrical ischemic gangrene over multiple sites of acral area, mostly extremities and sometimes nose, ear or scalp, without vascular occlusion or vasculitis. The pathogenesis is still unknown but related to local ischemia due to disseminated intravascular coagulation, infection, or medications. Case presentation: A 87 year-old Asian man was admitted to the intensive care unit under the impression of septic shock. Vasopressors were administered due to hypotension. However, bilateral cyanosis over limbs was noted gradually few days after the medications given. Dry gangrene over distal limbs developed even after we stopped the medication as early as possible. Discussion: Symmetrical peripheral gangrene may be an indicator for disseminated intravascular coagulation and poor prognosis. Quick reversal of underlying disease and elimination of precipitating factors are both significant managements once symmetrical peripheral gangrene is diagnosed.

Highlights

  • Symmetrical peripheral gangrene (SPG, or peripheral symmetrical gangrene, PSG) is defined as acute onset of symmetrical ischemic gangrene over multiple sites of acral area, mostly extremities and sometimes nose, ear or scalp, without vascular occlusion or vasculitis

  • Dopamine and Norepinephrine were commonly administered for critically ill patients, especially those under shock status

  • We present a case with septic shock developing symmetrical peripheral gangrene after administration of Dopamine and Norepinephrine

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Summary

Discussion

SPG is a rare condition frequently associated with high mortality and serious morbidity. Previous studies revealed the mortality rate ranged from 35 to 42% [6,7]. DIC secondary to infection was involved in most cases of SPG in previous studies [7,8]. The following E. coli septic shock and use of vasopressors in this patient have culminated in the development of SPG. In the setting of DIC, hemorrhagic patches may coexist with the peripheral gangrene (eg, purpura fulminans). SPG might be the only clinical presen-. Tation of DIC [3]. In this patient, the predominantly peripheral distribution of the gangrene lesions were the most dominant characteristics, and no purpura fulminans was noted

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