A Case of Symmetrical Peripheral Gangrene Secondary to Liver Transplantation

Abstract

Symmetrical peripheral gangrene (SPG) is a symmetric ischemic necrosis of the peripheral extremities without proximal arterial occlusion. We encountered an immunocompromised patient with pneumococcal pneumonia complicated by septic shock leading to SPG after chemotherapy for posttransplant lymphoproliferative disorders (PTLDs) secondary to the use of immunosuppressants after living-donor liver transplantation. In this case, symmetric necrosis of the peripheral extremities and necrosis of the nasal tip, apex of the tongue, central part of the lip, and tip of the penis were also observed. This is the first report of the development of SPG after living-donor liver transplantation. Necrosis extended beyond the extremities to the peripheral bloodstream with characterization of the symmetry.