Wegener's Granulomatosis and Gangrene in the Feet

A Rare Case of Digital Ischemia and Gangrene in ANCA-Associated Vasculitis with Review of the Literature

“…Only 3 patients demonstrated granulomas on biopsy. Confounding risk factors were inconsistently reported but include a past medical history of HTN in three cases [ 9 , 16 , 19 ], DM in three cases [ 13 , 15 , 16 ], tobacco use in two cases [ 13 , 18 ], and dyslipidemia in one case [ 13 ]. The clinical phenotype usually involves multiple disparate digits.…”

“…Only two cases (12%), including ours, have described simultaneous involvement of both the upper and lower extremities [ 20 ]. The pathophysiology of the digital ischemia and gangrene is thought to be from destruction of medium sized vessels from active vasculitis, which has been demonstrated in case reports where histological examination of affected tissue showed arteritis [ 9 , 15 ]. However, there is also evidence that in situ thrombosis, as a result of active vasculitis, can lead to ischemia and gangrene, as seen in angiographic examination of affected patients, as well as on histological examination of affected tissue showing arterial thrombi [ 12 , 13 ].…”

Wegener's granulomatosis and acute upper limb digital ischemia

“…A literature review revealed nine case reports of WG with digital ischemia 4–12 . Six reported cases involved patients with ischemia of their toes and three case reports involved upper limb digital ischemia.…”

Symmetrical Peripheral Gangrene in Disseminated Tuberculosis

“…Thus, vasculitis due to drugs [17] and bacterial [10,18], rickettsial [19], treponemal or viral [20][21][22] hematogenic dissemination may be complicated by SPG. Most often vasculitic SPG is due to collagen disease [6,23,24]. Very rarely, arterial calcification in uremia [25] and oxalosis [26] is complicated by SPG.…”

“…Tuberculosis 191 Table I. Mechanisms and conditions leading to symmetrical peripheral gangrene Hypotension shock [3] cardiac failure of different origin [4] treatment with beta-blocking agents [11] Vasoconstriction shock [3] frostbite [9] treatment with vasoactive agents ergotamine [5], vasopressin [13], dopamine [14] and chloroquine [16] secondary Raynaud's phenomenon [15] Endothelial damage treatment with bleomycin [17] bacterial sepsis [10,18] rickettsiosis [19] viral diseases: hepatitis B [20], measles [21], chickenpox [22] vasculitis of different origin [23,24] arterial calcification: uremia [25], oxalosis [26] carbon monoxide poisoning [12] Kaposi's sarcoma [27] black foot disease [28] Obliteration thromboembolic occlusion disseminated intravascular coagulation [21,32,33,44,45] cholesterol embolism [7] septic embolism [29] malaria [30] sickle cell anemia [18,38] essential thrombocythemia [35] heparin-induced thrombosis [39] polycythemia vera [34] hyperviscosity states cryoglobulinemia [36] paraproteinemia [36,40] hypernatrémie dehydration …”