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Year : 2016  |  Volume : 33  |  Issue : 1  |  Page : 97-98  

Acral gangrene in sepsis

Department of Pulmonary Critical Care and Sleep Medicine, The Mission Hospital, Durgapur, West Bengal, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Animesh Ray
Department of Pulmonary Critical Care and Sleep Medicine, The Mission Hospital, Durgapur, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-2113.173087

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How to cite this article:
Ray A, Das SK. Acral gangrene in sepsis. Lung India 2016;33:97-8

How to cite this URL:
Ray A, Das SK. Acral gangrene in sepsis. Lung India [serial online] 2016 [cited 2020 Jul 3];33:97-8. Available from: http://www.lungindia.com/text.asp?2016/33/1/97/173087

   Case Description Top

A 56-year-old female patient, a known diabetic without any other comorbidity, presented with complaints of fever with cough and expectoration for 4 days. On presentation, she was found to be hypotensive, hyporesponsive, and hypoxemic. Her chest x-ray and computed tomography (CT) of the thorax showed consolidation involving the left upper lobe [Figure 1]. She was intubated and mechanically ventilated and started on a high dose of vasopressors. From the third day of admission, she was found to have discoloration of the distal part of the fingers and toes. Endotracheal secretion, gram stain, and culture showed Pneumococcus and blood examination revealed features suggestive of acute kidney injury and disseminated intravascular coagulation (DIC). The blackish discoloration of the extremities increased progressively [Figure 2] and [Figure 3]. Arterial Doppler of the extremities showed decreased flow in the proximal arteries with absent flow in the distal arteries. Immunological markers were negative.
Figure 1: CT of the thorax showing consolidation of the left upper lobe

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Figure 2: Bluish discoloration and gangrene involving the upper extremities of the patient

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Figure 3: Gangrenous changes in the lower extremities of the patient

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   Questions Top

Q1: What is the diagnosis?

Q2: What are the risk factors? What are the common microorganisms involved?

Q3: What is the prognosis of the patient with such a condition?

Q4 What is the line of management in such a case?

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   References Top

McGouran RC, Emmerson GA. Symmetrical peripheral gangrene. Br Heart J 1977;39:569-72.  Back to cited text no. 1
Ghosh SK, Bandyopadhyay D, Ghosh A. Symmetrical peripheral gangrene: A prospective study of 14 consecutive cases in a tertiary-care hospital in eastern India. J Eur Acad Dermatol Venereol 2010;24:214-8.  Back to cited text no. 2
Parmar MS. Symmetrical peripheral gangrene: A rare but dreadful complication of sepsis. CMAJ 2002;167:1037-8.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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