BMJ Case Reports 2018; doi:10.1136/bcr-2017-223602
  • Rare disease

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock

Open Access
  1. Wayne Axman4
  1. 1Orthopedics, Division of Podiatry, Icahn School of Medicine at Mount Sinai, New York, USA
  2. 2Infectious Diseases, Mount Sinai Queens Hospital, Astoria, New York, USA
  3. 3Orthopedics, Division of Podiatry, Icahn School of Medicine at Mount Sinai, New York, USA
  4. 4Orthopedics, Division of Podiatry, Mount Sinai Queens Hospital, Astoria, New York, USA
  1. Correspondence to Dr Naeemah Ruffin, naeemahruffin{at}
  • Accepted 23 January 2018
  • Published 7 February 2018


We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand. Early monitoring and swift management of peripheral ischaemia are essential when using vasopressors for the treatment of septic shock.


  • Contributors All authors were involved in the treatment of this patient. WA discussed about writing the paper with SB and NR. NR initiated the concept, design, acquisition of data and literature review, and wrote the initial draft. SB acquired additional data and fact-checked each revision. WA and CVV analysed the article, revising each draft critically for important intellectual content. All authors approved the final version submitted. NR will ensure that all questions regarding the accuracy and integrity of the article are investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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