Clifford Anekeabout 6 years ago

Gangrene

We present a case of a 48-year-old lady who had a complaint of fever associated with chills and rigors for 3 weeks. She noticed darkening of right half of the upper limbs and all the digits of the both hands and feet, which was painful and progressive over a 1 week period. On physical examination, she was afebrile, dehydrated, and pale. There was no significant peripheral lymphadenopathy. The radial, femoral and popliteal pulses were all palpable. Examination of both upper and lower limbs revealed blackish discoloration of all digits of both hands up to the metacarpophalangeal joints, and all the toes extending up to middle third of the leg. The overlying skin was cold and dry with definite lines of demarcation between the gangrenous and normal skin. A clinical diagnosis of SPG (symmetrical peripheral gangrene) was considered. Initially, she underwent bilateral amputation below the knee joint. Two weeks after the first operation, bilateral digital amputations were carried out at the level of the metacarpophalangeal joints. Wound healing was uneventful and she was discharged from hospital 3 weeks later. She was given a referral for prosthesis of the lower limbs, but she is unable to afford it because of lack of funds. Symmetrical peripheral gangrene is a rare syndrome. It is characterized by bilateral distal ischemia leading to gangrene, in the absence of major vascular occlusive disease. It is considered a cutaneous marker of disseminated intravascular coagulation, and more than half of the patients who survive require amputation of the affected limbs. The etio-pathogenesis of SPG is not well understood, but the hallmark is the occurrence of microcirculatory failure. Credit: Friday S. Ejagwulu at anmjournal.com