ABSTRACT
Symmetrical peripheral gangrene (SPG) is a rare yet severe condition characterized by peripheral ischemic lesions without significant vascular occlusion. Its clinical presentation includes peripheral cyanosis, mottling, and symmetrical ischemia of distal limbs, often progressing to gangrene. Recent years have seen a rise in SPG cases, with mortality rates ranging from 40% to 90%. The condition is associated with systemic diseases, such as sepsis, vasculitis, and coagulopathy. DIC frequently complicates SPG, reflecting a disturbed procoagulant-anticoagulant balance and depletion of natural anticoagulants. While vasopressor therapy, particularly high-dose administration, has been implicated in SPG pathogenesis due to sustained vasoconstriction or idiosyncratic responses, recent evidence suggests it may not be the underlying cause. Studies indicate a low incidence of ischemic limb necrosis associated with high-dose vasopressors, with DIC and shock liver potentially explaining limb ischemia instead. The characteristic temporal interval between the onset of shock liver and limb ischemic necrosis suggests a more complex pathophysiology. The role of infectious agents, such as bacteria and viruses, in SPG pathogenesis is under investigation, with both direct vascular invasion and immune-mediated mechanisms proposed. Diagnosis involves ruling out other causes of acral gangrene through clinical examination, laboratory tests, imaging studies, and biopsy. Treatment strategies aim to halt disease progression, eliminate causative factors, and prevent complications. While anticoagulants, vasodilators, and adjunctive therapies like hyperbaric oxygen show promise, the efficacy of interventions varies, emphasizing the need for individualized management. Notably, hemoadsorption has emerged as a promising treatment, demonstrating significant improvement in SPG cases. Amputation remains a last resort option in irreversible cases. Early recognition and multidisciplinary management are crucial for improving outcomes. Further research is needed to better understand SPG's etiology and develop effective treatments through collaborative efforts.
ABSTRACT
This is a report of an unusual case of a primary psoas abscess due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in an immunocompetent man. The course of the disease is expressed as septic arthritis of the hip joint with avascular necrosis. Diagnosed one month after symptoms began, the patient was treated by surgical evacuation of the abscess and appropriate antibiotics. Full recovery and return to his usual activity followed total hip replacement.
ABSTRACT
BACKGROUND Airway compromise caused by massive fluid extravasation in association with arthroscopic shoulder surgery is rare. However, it is even more rare to occur as a result of pleural effusion. We present this case to increase the awareness of this rare complication and show how to minimize the likelihood of this uncommon incident. CASE REPORT We describe a case of a 68-year-old woman who underwent elective shoulder arthroscopy for rotator cuff repair. She had immediate postoperative shortness of breath and was found to have bilateral pulmonary edema and pleural effusion accompanied by metabolic acidosis. She was managed conservatively in the intensive care unit and then transferred to the general ward after clinical and radiological improvement the next day. CONCLUSIONS This uncommon complication was self-limiting, and the patient recovered uneventfully. High clinical suspicion is required to address this event so proper rapid management can be made.
