Prof. Phill Dellinger: "Symmetric Peripheral Gangrene: an underrecognized entity in the septic shock patient"

Acute focal and generalized peripheral ischemia are seen in a wide array of acute illnesses. The term symmetric peripheral gangrene (SPG) is most often used to describe generalized peripheral ischemia that is associated with disseminated intravascular coagulation (DIC) induced microvascular thrombosis leading to gangrene with symmetric acral(peripheral body parts) distribution. SPG is usually caused by infection-induced DIC and when present often co-exists with sepsis-induced multi-organ dysfunction/failure as well as septic shock. Since many of these patients are receiving vasopressors SPG is often misdiagnosed as vasopressor induced peripheral ischemia. Since cases are rare, there is no evidence-based medicine that supports any particular treatment. We will discuss the pathophysiology and differential diagnosis of SPG as well as potential treatments based on chalkboard logic and case report anecdotal experience.