Symmetrical peripheral gangrene: a prospective study of 14 consecutive cases in a tertiary-care hospital in eastern India

• Published in: Journal of the European Academy of Dermatology and Venereology 2010-02, Vol.24 (2), p.214-218
• Main Authors: Ghosh, SK, Bandyopadhyay, D, Ghosh, A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; disseminated intravascular coagulation; eastern India; Female; Gangrene - diagnosis; Gangrene - epidemiology; Humans; India - epidemiology; limb amputations; Male; Middle Aged; Prospective Studies; purpura fulminans; septicaemia; symmetrical peripheral gangrene
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2009.03329.x

Background  Symmetrical peripheral gangrene (SPG) is characterized by sudden onset of peripheral, frequently symmetrical gangrene in the absence of major vascular occlusive disease. SPG is associated with a wide range of underlying medical problems and usually has disseminated intravascular coagulation (DIC) in the background. Although sporadic cases and a few retrospective case series of SPG have been reported, lack of any prospective study on the profile and outcome of these patients prompted us to undertake the present work. Objectives  To study the clinical profile, aetiological factors, and outcome of a group of patients of SPG from eastern India. Patients/methods  Prospective, observational study of consecutive patients presented at or referred to the Dermatology Department of a tertiary‐care hospital during 2001 to 2008. Results  We observed 14 patients (5 males, 9 females; mean age: 43.36 years) of SPG during the study period. All had clinical and laboratory evidence of DIC in association with a shock syndrome. Associated purpura fulminans was noted in 11 patients. In 12 patients, the cause of SPG was infective, Pneumococcus being the commonest organism involved. Two patients developed DIC and SPG postoperatively. Nine patients survived and the remaining five patients died. Three patients had leukopenia and all of them died. Amongst the survivors, four patients had auto‐amputation of some parts of distal limbs; surgical amputation was done in two patients. Conclusions  SPG carries a high mortality rate frequently requiring multiple limb amputations in survivors. Leukopenia may be a poor prognostic factor of SPG and DIC may occur universally.