Symmetrical Peripheral Gangrene after Using High-Dose Inotropes

Symmetrical peripheral gangrene (SPG) is an uncommon but devastating complication in critically ill patients with a high mortality. It is seen in a wide variety of medical conditions, presenting as symmetrical gangrene of two or more extremities without large vessel obstruction. We hereby report a 65-year-old woman diagnosed of having E. coli bacteremia with urosepsis, who presented with acute abdomen, consciousness disturbance and multiple organ failure. Owing to low blood pressure and unstable hemodynamic status, inotropic agents with maximum dose of dopamine at 12.7 μg/kg/min and levophed of 2.6 μg/min were used. On the 4 day of admission, patient developed cyanosis and gangrene of fingers and toes. However, even with the dose of inotropic agents tapered, the cyanosis and gangrene did not resolve. Autoamputation developed and the patient underwent multiple surgical amputations of her fingers and toes. Patient also developed acute kidney injury with anuria and pulmonary edema, thus necessitating hemodialysis treatment.