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      Meningococcal Sepsis Complicated by Symmetrical Peripheral Gangrene: A Case Report

      case-report
      Author(s): 1 , , 1 , 2 , 3 , 1 , 1
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: meningococcal sepsis, symmetrical peripheral gangrene, sepsis, dic, amputation

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          Abstract

          Symmetrical peripheral gangrene (SPG) is a rare complication of septicaemia and disseminated intravascular coagulation (DIC) characterised by distal ischaemia in two or more extremities without large vessel obstruction. SPG has high mortality and morbidity rates, though consensus guidelines for management have yet to be produced.

          We herein present the case of a 28-year-old woman with meningococcal septicaemia complicated with extensive bilateral upper and lower limb SPG.

          We discuss the various management options of SPG. While reported cases are scarce in the literature, early recognition of sepsis and prompt withdrawal of vasoconstrictors in an intensive care setting, combined with timely heparinisation, appear to be the most common management strategy thus far.

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          Symmetrical peripheral gangrene and disseminated intravascular coagulation.

          Daniel Hall, M Molos (1985)
          Symmetrical peripheral gangrene (SPG) is a rare syndrome associated with a multitude of underlying medical problems. We are adding three cases of SPG to the medical literature, all of which had disseminated intravascular coagulation (DIC). Each had an underlying illness that, to our knowledge, has not been previously associated with SPG: Hodgkin's lymphoma, Escherichia coli urinary tract infection with septicemia, and polymyalgia rheumatica. Review of the medical literature shows a high association between SPG and DIC. Symmetrical peripheral gangrene should therefore be considered a cutaneous marker of DIC. Early recognition and treatment of the underlying medical problem and DIC could be lifesaving.
          Article 0 comments Cited 37 times – based on 0 reviews     Review now
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            Symmetrical peripheral gangrene: a prospective study of 14 consecutive cases in a tertiary-care hospital in eastern India.

            S. Ghosh, Kuntal A. Ghosh, D Bandyopadhyay (2010)
            Symmetrical peripheral gangrene (SPG) is characterized by sudden onset of peripheral, frequently symmetrical gangrene in the absence of major vascular occlusive disease. SPG is associated with a wide range of underlying medical problems and usually has disseminated intravascular coagulation (DIC) in the background. Although sporadic cases and a few retrospective case series of SPG have been reported, lack of any prospective study on the profile and outcome of these patients prompted us to undertake the present work. To study the clinical profile, aetiological factors, and outcome of a group of patients of SPG from eastern India. Prospective, observational study of consecutive patients presented at or referred to the Dermatology Department of a tertiary-care hospital during 2001 to 2008. We observed 14 patients (5 males, 9 females; mean age: 43.36 years) of SPG during the study period. All had clinical and laboratory evidence of DIC in association with a shock syndrome. Associated purpura fulminans was noted in 11 patients. In 12 patients, the cause of SPG was infective, Pneumococcus being the commonest organism involved. Two patients developed DIC and SPG postoperatively. Nine patients survived and the remaining five patients died. Three patients had leukopenia and all of them died. Amongst the survivors, four patients had auto-amputation of some parts of distal limbs; surgical amputation was done in two patients. SPG carries a high mortality rate frequently requiring multiple limb amputations in survivors. Leukopenia may be a poor prognostic factor of SPG and DIC may occur universally.
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              Symmetrical peripheral gangrene: association with noradrenaline administration.

              M A Hayes, E Yau, C Hinds … (1992)
              The syndrome of symmetrical peripheral gangrene is characterised by distal ischaemic damage in two or more extremities, without large vessel obstruction. Four patients with bilateral pedal ischaemia are described and their haemodynamic profiles presented. In all four cases the syndrome developed in association with noradrenaline administration, sepsis and DIC, despite a high cardiac output and a low calculated systemic vascular resistance index. Early treatment with epoprostenol was instituted in the final case and was successful.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 30 July 2020
                Publication date (Electronic, collection): July 2020
                Volume: 12
                Issue: 7
                Electronic Location Identifier: e9470
                Affiliations
                [1 ] General Surgery, Connolly Hospital Blanchardstown, Dublin, IRL
                [2 ] Medicine, The Mater Misericordiae University Hospital, Dublin, IRL
                [3 ] Medicine, Connolly Hospital Blanchardstown, Dublin, IRL
                Author notes
                Article
                DOI: 10.7759/cureus.9470
                PMC ID: 7455390
                SO-VID: 39996aed-2abd-4f9b-a47c-ed6da6d70801
                Copyright © Copyright © 2020, Ennis et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 31 March 2020
                Date accepted : 19 July 2020
                Categories
                Subject: Anesthesiology
                Subject: Emergency Medicine
                Subject: Infectious Disease

                Keywords: meningococcal sepsis,symmetrical peripheral gangrene,sepsis,dic,amputation
                Data availability:
                Keywords: meningococcal sepsis, symmetrical peripheral gangrene, sepsis, dic, amputation

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