Meningococcal Sepsis Complicated by Symmetrical Peripheral Gangrene: A Case Report

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.

Idiopathic Symmetrical Peripheral Gangrene: A Rare Clinical Entity

“…Reports in literature have also associated this entity with infections such as malaria, dengue, and meningococcemia [3,6,7]. Other causes include sickle cell anemia, cold agglutinin disease, and inotrope use.…”

“…It classically occurs bilaterally and in the absence of an established thrombotic disease. Disseminated intravascular coagulation (DIC) is central to the pathogenesis of SPG, with certain hypercoagulable states presumed to play a role in disease initiation [2,3]. This knowledge is important as the management of SPG is aimed at reversal of DIC and the causative phenomenon.…”

Recovery of Symmetrical Peripheral Gangrene of Limbs in a Patient After Performing Hemoadsorption in Septic Shock

“…The etiology of SPG is multifactorial, but septic shock and DIC are the leading causes 8,12‐15 . Sepsis is currently defined as a dysregulated host immune response to infection leading to organ failure 16‐18 .…”

“…Pathogen‐associated molecular patterns and damage‐associated molecular patterns play a significant role in activating the endothelium and as a result inflammatory cytokines 19 . The activated endothelium becomes prothrombotic through increases in the expression of tissue factor in the endothelium and monocytes 12,18 . DIC develops in cases of impaired balance of anti‐ and pro‐coagulant factors.…”

“…Early findings of septicemia‐associated DIC include apparent coldness, pallor, and pain. The ischemic lesions are often demarcated sharply and symmetric with initial gray, blue, or purple discoloration that progresses to black as the skin undergoes necrosis 12,18 …”