Rare case of symmetrical peripheral gangrene due to septic shock, disseminated intravascular coagulation and inotropic use

Introduction

Symmetrical peripheral gangrene (SPG) is a rare syndrome defined by the peripheral ischemic lesion of two or more extremities in the absence of major vascular obstructive disease.

Presentation of case

A 45yo woman, admitted in intensive care unit due to urinary septic shock, in need of high doses of amines, developed cold extremities with acrocyanosis that rapidly progressed to gangrene. Laboratory analysis revealed increased inflammatory parameters, liver shock, thrombocytopenia, prolonged coagulation times, increased D-Dimers and isolation of Acinetobacter baumanni in urine culture. An intravenous vasodilator was initiated with clinical benefits. After improvement and delimitation of the lesions, the patient underwent the amputation of the distal phalanges of the 2nd, 3rd and 4th fingers of the right hand and the toes of both feet.

Discussion/conclusion

Even though there is no consensus regarding SPG treatment, consequences should be mitigated, particularly when vasodilators are used, in order to avoid major amputation.

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Symmetrical Peripheral Gangrene (SPG), although rare, must be immediately recognized because of its harmful consequences.

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SPG has a high mortality rate and a high percentage of the survivors have at least one limb amputated.

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The necessary measures should be taken in a timely manner to mitigate consequences.

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Treatment of the infection, the avoidance of vasopressors, and the use of LMWH and vasodilators, seem to be important to reduce major amputation.