Symmetrical peripheral gangrene in a chronic kidney disease patient on hemodialysis

Symmetrical peripheral gangrene (SPG) is a rare but well-described condition characterized by ischemic changes in the distal limbs with preserved flow in the major vessels. It results from thrombosis of the microcirculation resulting from a complex interplay of infectious and non-infectious factors. Often described as a complication of disseminated intravascular coagulation (DIC), it has got multiple aggravating factors. Timely recognition and management is important as significant residual disability is noted in surviving patients. Here, we describe a patient with chronic kidney disease on maintenance hemodialysis presenting with SPG associated with spontaneous bacterial peritonitis and DIC. She had multiple aggravating factors such as hypotension, use of inotropes, and renal failure. As there were no evidence-based guidelines and since the general condition of the patient was poor, she was managed with supportive care.

Symmetrical Peripheral Gangrene – A Rare Clinical Manifestation of Hodgkin’s Lymphoma

Symmetrical peripheral gangrene (SPG) is a cutaneous manifestation of a wide array of infective and noninfective etiological factors and occurs due to hypoxemia, vasoconstriction, primary endothelial damage and/or decreased cardiac output. It is a devastating complication of underlying septicemia and disseminated intravascular coagulation (DIC) with a high mortality rate and commonly requiring amputation of the affected limb in those who survive. We here describe a case that presented with fever, cough, blackish discoloration of fingers and generalized lymphadenopathy. Investigation revealed anemia, leukocytosis, coagulopathy and positive D-dimer test. Fine-needle aspiration cytology (FNAC) showed evidence of Hodgkin’s lymphoma.

A complicated case of Plasmodium falciparum malaria with symmetrical peripheral gangrene with a review of literature.

Malaria causes nearly one million deaths each year and with its recent re-emergence, several fatal complications are seen such as cerebral malaria, hypotension or shock, renal failure, pulmonary oedema/adult respiratory distress syndrome, and hypoglycaemia. Symmetric peripheral gangrene (SPG) is a severe but extremely rare complication of malaria. It has a rapid and sudden onset leading to necrosis which cannot be reversed. A 26 year old male was admitted and treated for complicated malaria and developed SPG. He was given intravenous artesunate, doxycyline, clopidogrel and acetyl salicyclic acid for the gangrene; however, he went into multiple organ dysfunction syndrome and septic shock and thus could not be resuscitated. We report this case to highlight that physicians treating malaria should always look for these signs for timely correction and to improve the patient outcome.

Symmetrical peripheral gangrene: A rare complication of dengue fever.

Symmetric peripheral gangrene is associated with a variety of infective and non-infective etiologies. SPG is always presented with disseminated intravascular coagulation (DIC) and carries a higher mortality. Herein, we describe a 42-year-old female with dengue fever and rash developed bilateral symmetric dry gangrene of 2 nd and 3 rd toes. There was no history of taking B-blockers, ergot etc. All the peripheral pulses of the affected limbs were palpable. Color Doppler of lower limb vessels was done, which indicated normal flow. Blood was positive for Fibrin degradation products and D dimers. Patient was managed with IV fluids, LMWH, FFP etc. Her general condition improved within 72 hours with no further progression of gangrene.

Gangrena simétrica periférica vinculada a coagulación intravascular diseminada, shock séptico e infusión de noradrenalina / Symmetric peripheral gangrene linked to coagulation disseminated intravascular septic shock and infusion of noradrenaline

Introducción: Los intensivistas se enfrentan habitualmente con cuadros clínicos que pueden producir el síndrome de gangrena simétrica periférica. Al reconocer esta posibilidad, pueden prevenirlo, atenuarlo o revertirlo y reducir la morbimortalidad. Presentación del caso: Varón de 34 años con antecedentes de alcoholismo que se presenta con sepsis grave secundaria a absceso de pulmón derecho. Evolucionó con coagulación intravascular diseminada, requirió altas dosis de noradrenalina y tuvo gangrena acral en las cuatro extremidades. Finalmente falleció. Conclusiones: La combinación de shock e hipoperfusión, altas dosis de vasopresores y coagulación intravascular diseminada se vincula con la gangrena simétrica periférica que sufrió nuestro paciente. El manejo terapéutico de la gangrena simétrica periférica es multidisciplinario. (AU)

Introduction: Intensivists are confronted regularly with clinical and therapeutic conditions that can produce symmetrical peripheral gangrene syndrome. Knowing this possibility, they may prevent, attenuate and/or reverse it, and reduce its morbidity and mortality. Case presentation: A 34 years old man with history of alcoholism who presented with severe sepsis due to right lung abscess. The patient developed disseminated intravascular coagulation, he required high doses of noradrenaline infusion and he had acral gangrene in the four limbs. Finally he died. Conclusions: The combination of shock and hypoperfusion, high doses of vasopressors and disseminated intravascular coagulation is associated with the symmetrical peripheral gangrene presented by our patient. The therapeutic management of the symmetrical peripheral gangrene is multidisciplinary.(AU)

Community Acquired Methicillin Resistant Staphylococcus Aureus: A Rare Presentation.

Introduction Incidence of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) is increasing. Toxic shock syndrome (TSS), Necrotizing fasciitis (NF), Symmetrical peripheral gangrene (SPG) as a manifestation of CA-MRSA are rare in pediatrics. Case Presentation We report a young boy who presented with TSS, NF and SPG by CA-MRSA following trauma. Conclusion CA-MRSA should be taken into consideration as an etiology for these type of clinical presentations. Early and aggressive surgical and medical intervention are the cornerstone for successful management.

Symmetrical Peripheral Gangrene after Pulmonary Hemorrhage / 대한정형외과학회잡지

Symmetrical peripheral gangrene (SPG) is characterized by distal ischemic damage in two or more extremities without a large vessel obstruction. This syndrome is associated with low cardiac output, sepsis, malignancy, disseminated intravascular coagulation (DIC) and the administration of vasoactive drugs. We report a case of SPG in a patient with pulmonary hemorrhage, sepsis and DIC who had been administered dopamine.

A Case of Symmetrical Peripheral Gangrene Complicating Escherichia coli Sepsis / 감염과화학요법

We have encountered a rare case of symmetrical peripheral gangrene complicating Escherichia coli sepsis in a 47-years-old male. He was successfully treated with antibiotics, anticoagulants, and vasodilator. To our knowledge, this is the first report on symmetrical peripheral gangrene complicating E. coli sepsis in Korea.

A Case of Symmetrical Peripheral Gangrene Complicating Escherichia coli Sepsis / 감염과화학요법

We have encountered a rare case of symmetrical peripheral gangrene complicating Escherichia coli sepsis in a 47-years-old male. He was successfully treated with antibiotics, anticoagulants, and vasodilator. To our knowledge, this is the first report on symmetrical peripheral gangrene complicating E. coli sepsis in Korea.

Hemophagocytic Syndrome with Kawasaki Disease and Peripheral Gangrene

A twenty six months-old boy developed hemophagocytic syndrome during the course of Kawasaki disease. Despite the appropriate treatment modalities for Kawasaki disease, he developed thrombocytopenia, hepatomegaly, high-grade fever, hypertriglyceridemia, peripheral gangrene, and evidence of hemophagocytosis in bone marrow biopsy. Although the course was stormy, he responded well to a combination therapy of corticosteroid and etoposide.

Peripheral gangrene in a fatal pediatric cerebral malaria: A case report.

A Thai male aged 10 years from Kanchanaburi, was referred to Paholpolpayuhasana hospital decause of ceredral malaria. During his hospital stay, the patient developed multiple complications including gangrene of both feet which was seen 24 hours after admission. This patient was haematemesis. The laboratory results revealed thrombocytopaenia and an abnormal coagulogram but there was no evidence of septicaemia. The patchy lesions of peripheral gangrenr progressed slowly and stoped after 48 hours. After 5 days of treatment, the patient became aparasitaemic but he developed acute renal failure on day 6 and died of pulmonary oedema on day 7. In agreement with a previous report, this report confirms that peripheral gangrene is a rare complication in Thai pediatric cerebral malaria patients. This complication can develop both in other multiple complications.