S K Ghosh1, D Bandyopadhyay, A Ghosh. 1. Department of Dermatology, Venereology, and Leprosy, R.G.Kar Medical College, Kolkata, India. dr_skghosh@yahoo.co.in
Abstract
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.
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.