Septic shock-induced by a symmetrical peripheral gangrene

Abstract

Introduction: Symmetrical peripheral gangrene is defined, from the clinical point of view as the sudden development of purpura and gangrene of two or more distal zones (hands, feet, and nose and genital zones).
Clinical case: It is described a case report of a previously healthy 14 year-old female admitted to the Instituto Ecuatoriano de Seguridad Social de Ibarra hospital, in Imbabura, Ecuador. She was admitted because of a septic shock with organ failure, secondary to bacterial pneumonia that required high-dose vasoactive drugs. Eventually, the patient developed diffuse violaceous skin lesions in distal areas and necrotic-ischemic zones, especially in distal areas such as tips of fingers and toes.
Discussion: Symmetrical peripheral gangrene was diagnosed, concluded to be as a result of intravascular disseminated coagulation. Serial blood cultures did not isolate any specific pathogens. However, a strand of Burkholderiacepacia was isolated in the tracheal secretion sample culture. She was treated with hemodynamic support measures, broad spectrum antibiotics, corticosteroids, daily wound cures. The distal phalanxes of the second left toe and of the third and fourth right toes were amputated.
Conclusion: Gangrenous symmetrical skin manifestations can be considered as a great value marker in patients with disseminated intravascular coagulation as a complication of septic shock.