| Abstract | Bacterial sepsis is only infrequently accompanied by peripheral ischemia. However, we have managed 10 patients with symmetrical peripheral gangrene (purpura fulminans) accompanying pneumococcal sepsis (Streptococcus pneumoniae) during the past 15 years at a single institution. In only two (20%) of these patients could vasoconstrictor administration be implicated as contributory to gangrene. The clinical scenario was characterized by pneumococcal bacteremia, admission to the medical intensive care unit, normal proximal arterial perfusion, and symmetrical full-thickness digital and distal extremity ischemia leading to cutaneous gangrene. Three (30%) of these patients died. The failure of anticoagulant and antiplatelet agents as therapy and the successful reversal of impending digital gangrene in one patient by sympathetic blockade suggest that the initial underlining pathophysiology is vasoconstrictive rather than thrombotic in nature. Effective management includes appropriate antibiotic therapy, avoidance of early operative intervention, conservative local débridement, and secondary skin grafting. |
| Authors | K Johansen, S T Hansen Jr
(Affiliation: Department of Surgery, University of Washington School of Medicine, Seattle.)
|
| Journal | American journal of surgery
(Am J Surg)
Vol. 165
Issue 5
Pg. 642-5
(May 1993)
ISSN: 0002-9610 UNITED STATES |
| PMID | 7683845
(Publication Type: Journal Article)
|
| Chemical References |
- Adrenal Cortex Hormones
- Aspirin
- Dopamine
- Dextrans
- Streptokinase
|
| Topics |
- Adrenal Cortex Hormones
(therapeutic use)
- Amputation
- Aspirin
(therapeutic use)
- Debridement
- Dextrans
(therapeutic use)
- Dopamine
(administration & dosage)
- Fingers
(blood supply)
- Foot
(blood supply)
- Gangrene
- Humans
- Ischemia
(etiology, therapy)
- Pneumococcal Infections
(pathology, therapy)
- Skin Transplantation
- Streptokinase
(therapeutic use)
|
