Citation Information :
Masaragian H, Rega L, Ameriso N, Perin F, Coria H, Mizdraji L, Cicarella S. Distal Ischemia of the Four Limbs: A Case Report and Literature Review. J Foot Ankle Surg Asia-Pacific 2019; 6 (2):46-51.
The symmetrical peripheral gangrene syndrome is characterized by ischemic distal lesions in two or more extremities, without the obstruction of large vessels. The ischemia affecting extremities takes place when the arterial blood flow is insufficient to satisfy the metabolic demands of muscles in rest. We present a 22-year-old patient treated with norepinephrine after a septic shock suspicion who presented distal ischemia of fingers, toes, and scalp. There is no consensus about the initial treatment. Improved data gathering is necessary for a better understanding of the mechanisms involved, which could improve treatment and prevent amputation as the final therapeutic option.
Hutchinson J. Notes of uncommon cases. Br Med J 1891;2(1592):8–9. DOI: 10.1136/bmj.2.1592.8.
Molos MA, Hall JC. Symmetrical peripheral gangrene and disseminated intravascular coagulation. Arch Dermatol 1985;121(8):1057–1061. DOI: 10.1001/archderm.1985.01660080111027.
Johansen K, Murphy T, Pavlin E, et al. Digital ischemia complicating pneumococcal sepsis: reversal with sympathetic blockade. Crit Care Med 1991;19(1):114–116. DOI: 10.1097/00003246-199101000- 00025.
Winkler MJ, Trunkey DD. Dopamine gangrene: association with disseminated intravascular coagulation. Am J Surg 1981;142(5): 588–591. DOI: 10.1016/0002-9610(81)90432-3.
Hayes MA, Yau EHS, Hinds CJ, et al. Symmetrical peripheral gangrene: association with noradrenaline administration. Intensive Care Med 1992;18(7):433–436. DOI: 10.1007/BF01694349.
Simman R, Phavixay L. Bilateral toe necrosis resulting from norepinephrine bitartrate usage. Adv Skin Wound Care 2013; 26(6):254–256. DOI: 10.1097/01.ASW.0000431083.77517.fd.
Shin JY, Roh S, Lee N, et al. Ischemic necrosis of upper lip, and all fingers and toes after norepinephrine use. J Craniofac Surg 2016;27(2):453–454. DOI: 10.1097/SCS.0000000000002463.
Forrest CR, Pang CY, Zhong AG, et al. Role of noradrenaline in the pathogenesis of skin flap ischemic necrosis in the pig. J Surg Res 1990;48(3):237–244. DOI: 10.1016/0022-4804(90)90219-R.
Kim EH, Lee SH, Byun SW, et al. Skin necrosis after a low-dose vasopressin infusion through a central venous catheter for treating septic shock. Korean J Intern Med 2006;21(4):287–290. DOI: 10.3904/kjim.2006.21.4.287.
Ghosh SK, Bandyopadhyay D. Symmetrical peripheral gangrene. Indian J Dermatol Venereol Leprol 2011;77(2):244–248. DOI: 10.4103/0378-6323.77481.
Levy JH, Ghadimi K, Faraoni D, et al. Ischemic limb necrosis in septic shock: what is the role of high-dose vasopressor therapy? J Thromb Haemost 2019;17(11):1973–1978. DOI: 10.1111/jth.14566.
Albano MN, Brazão SG, Caroço TV, et al. Rare case of symmetrical peripheral gangrene due to septic shock, disseminated intravascular coagulation and inotropic use. Ann Med Surg (Lond) 2018;35:103–107. DOI: 10.1016/j.amsu.2018.09.025.
Jung KJ, Nho JH, Cho HK, et al. Amputation of multiple limbs caused by use of inotropics. Medicine (Baltimore) 2018;97(5):e9800. DOI: 10.1097/MD.0000000000009800.
Tan JH, Mohamad Y, Tan CLH, et al. Concurrence of symmetrical peripheral gangrene and venous limb gangrene following polytrauma: a case report. J Med Case Rep 2018;12(1):131. DOI: 10.1186/s13256-018-1684-1.
Vidal C, Moulin F, Nassif X, et al. Fulminant arterial vasculitis as an unusual complication of disseminated staphylococcal disease due to the emerging CC1 methicillin-susceptible Staphylococcus aureus clone: a case report. BMC Infect Dis 2019;19(1):302. DOI: 10.1186/s12879-019-3933-3.
