Images in Clinical Medicine
Symmetric Peripheral Gangrene
N Engl J Med 2001; 344:1593May 24, 2001
- Article
Figure 1 Fevers, chills, hypotension, and a generalized seizure occurred in a 57-year-old man who had undergone splenectomy for stage IV non-Hodgkin's lymphoma three years earlier. He was treated initially with ceftriaxone, vancomycin, and rifampin. A Gram's stain of the cerebrospinal fluid showed gram-positive organisms in pairs and short chains, but cultures of cerebrospinal fluid were negative. A latex-agglutination test was positive for Streptococcus pneumoniae. During the next several days, disseminated intravascular coagulation and symmetric areas of pallor developed on the back of both hands and the soles of the feet, with overlying bullae. Cultures of the bullous fluid were sterile. The lesions progressed to dry gangrene (Panels A and B). All blood cultures remained negative. The patient was treated with antibiotics for four weeks. The arterial supply to each of the arms and legs remained patent. Although the patient had been vaccinated against S. pneumoniae at the time of his splenectomy, he showed a protective antibody response to only 8 of 12 serotypes tested. He was revaccinated. The images are typical of symmetric peripheral gangrene associated with S. pneumoniae bacteremia in a patient whose spleen has been removed.
M. Michelle Berrey, M.D., M.P.H.
Jo-Anne van Burik, M.D.
University of Washington, Seattle, WA 98109- Citing Articles (1)
Citing Articles
1
Ó. Suárez-Amor, R. Casado-Arroyo, M. Cabanillas, J. Labandeira, J. Toribio. (2009) Symmetrical Peripheral Gangrene and Disseminated Intravascular Coagulation Associated With Pneumococcal Sepsis. Actas Dermo-Sifiliográficas (English Edition) 100:4, 334-335
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