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Case Reports
. 2018 Feb 7:2018:bcr2017223602.
doi: 10.1136/bcr-2017-223602.

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

Naeemah Ruffin  1 , Chirag V Vasa  2 , Sarah Breakstone  1 , Wayne Axman  3
Affiliations
Case Reports

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

Naeemah Ruffin et al. BMJ Case Rep. .

Abstract

We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand. Early monitoring and swift management of peripheral ischaemia are essential when using vasopressors for the treatment of septic shock.

Keywords: adult intensive care; contraindications and precautions; infections; unwanted effects / adverse reactions.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The left hand after amputation of digits 1, 4 and 5.
Figure 2
Figure 2
Demarcated gangrene on the dorsal aspect of both feet.
Figure 3
Figure 3
Demarcated gangrene on the plantar aspect of both feet.
Figure 4
Figure 4
Both feet 3 months after transmetatarsal amputations and application of Versaflow wound VAC.
Figure 5
Figure 5
Both feet after application of split-thickness skin grafts.
See this image and copyright information in PMC

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