SYMMETRICAL PERIPHERAL GANGRENE OF BILATERAL HANDS AND UNILATERAL FOOT IN SETTING OF SEPTIC SHOCK REQUIRING PROLONGED HIGH DOSE VASOPRESSORS

Symmetrical peripheral gangrene (SPG) is characterized by progressive ischemic damage in two or more extremities, without large vessel obstruction. This syndrome has been reported in several etiologies such as infections, disseminated intravascular coagulation (DIC), and low cardiac output states. It is also known as purpura fulminans (PF). It carries a risk of limb amputation leading long term morbidity and higher rates of mortality due to prolonged hospitalisation.1 SPG is the sign of progressive disseminated intravascular coagulation (DIC). The main pathogenesis theory, is microthrombosis associated with disturbed pro coagulant–anticoagulant balance, leading to tissue necrosis. The treatment thus involves aggressive treatment of root cause and theoretically involves heparin-based anticoagulation.2.