phenylephrine-hydrochloride and Gangrene

A 42-year-old woman with a history of acute myeloid leukaemia status postallogeneic stem cell transplant presented with fevers, altered mental status, pulmonary infiltrates and septic shock that further progressed to thrombocytopenia and purpura fulminans. Laboratory studies were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Blood cultures grew

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diagnosis, Differential; Female; Fibrinolytic Agents; Fingers; Gangrene; Glucocorticoids; Graft vs Host Disease; Humans; Immunologic Factors; Leukemia, Myeloid, Acute; Nose; Plasma Exchange; Pneumococcal Infections; Purpura Fulminans; Purpura, Thrombotic Thrombocytopenic; Rituximab; Shock, Septic; Single-Domain Antibodies; Stem Cell Transplantation; Toes

Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes.. A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died.. In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC.. In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

Topics: Acute Disease; Aged; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Disseminated Intravascular Coagulation; Doxycycline; Female; Fingers; Gangrene; Humans; Hydroxychloroquine; Nasal Cavity; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Severity of Illness Index

Capnocytophaga canimorsus is a bacterium transmitted through the saliva of dogs. An infection can cause severe sepsis with acral necrosis and is potentially fatal. Here, we report the case of a 41-year-old man who was infected through a wound that was licked by his dog. He went into septic shock with disseminated intravascular coagulation and subsequently lost both lower legs, his nose and all the fingers on both hands.

Topics: Adult; Amputation, Surgical; Animals; Bites and Stings; Capnocytophaga; Dogs; Fingers; Gangrene; Gram-Negative Bacterial Infections; Humans; Leg; Male; Nose; Saliva; Shock, Septic; Treatment Outcome

Topics: Ear Auricle; Gangrene; Heart Arrest; Humans; Iris; Ischemia; Male; Middle Aged; Mydriatics; Nose; Pupil; Pupil Disorders; Thoracic Wall; Vasoconstrictor Agents; Visual Acuity

Topics: Adult; Antiphospholipid Syndrome; Female; Foot; Gangrene; Hand; Humans; Nose

Topics: Arteries; Biocompatible Materials; Collagen; Embolism; Female; Gangrene; Humans; Hyaluronic Acid; Injections; Middle Aged; Necrosis; Nose; Skin

Two male patients with chronic renal failure maintained on hemodialysis developed progressive clinical features of ischemic necrosis (so called calciphylaxis) of their extremities and penis. Both patients died. In one patient, penectomy provided tissue for histopathologic examination and there were changes of small artery calcification. A role of iron overload on the production of calciphylaxis is reviewed. This report is perhaps the first in nephrology literature on the occurrence of calciphylaxis involving penis and prepuce.

Topics: Aged; Arterial Occlusive Diseases; Calciphylaxis; Fatal Outcome; Foot; Gangrene; Hand; Humans; Iron; Ischemia; Kidney Failure, Chronic; Male; Necrosis; Nose; Penile Diseases; Penis; Renal Dialysis; Uremia

Topics: Adult; Ear; Gangrene; Humans; Leg; Lip; Male; Necrosis; Nose; Pneumococcal Infections; Purpura; Skin

Topics: Child; Ecthyma; Female; Gangrene; Humans; Leukemia, Myeloid, Acute; Necrosis; Nose; Opportunistic Infections; Osteonecrosis; Pseudomonas Infections; Skin

Skin and soft tissue necrosis is an uncommon but increasingly recognized complication of coumarin anticoagulant therapy. A patient is described with extensive involvement of all four extremities and the nose, requiring amputation of three extremities. The characteristic clinical features of the disorder are reviewed, with a discussion of the pathology, pathogenesis, and possible treatment modalities.

Topics: Aged; Connective Tissue; Extremities; Female; Gangrene; Humans; Necrosis; Nose; Skin; Warfarin

We report a case of an adult mid-face reconstruction for a deformity occurring in infancy, using a Le Fort III advancement first to restore the contour of the skeleton. This was followed by a scalping forehead flap for the nasal reconstruction, and a fleur-de-lis Abbe flap for reconstruction of the lip and nasal vestibule.

Topics: Adult; Cheek; Dentures; Face; Female; Gangrene; Humans; Ilium; Inguinal Canal; Lip; Nose; Skin Transplantation; Surgery, Plastic; Transplantation, Autologous

Topics: Adult; Endocarditis, Subacute Bacterial; Female; Gangrene; Humans; Nose

Topics: Aged; Arm; Bacterial Infections; Ear Diseases; Ear, External; Escherichia coli Infections; Female; Foot; Foot Diseases; Gangrene; Hand; Humans; Hypotension; Ischemia; Klebsiella Infections; Leg; Male; Middle Aged; Nose; Nose Diseases; Pneumococcal Infections; Pseudomonas Infections; Sepsis; Thrombosis

Topics: Bone Transplantation; Child, Preschool; Cleft Lip; Female; Gangrene; Humans; Nose; Rhinoplasty; Skin Transplantation; Transplantation, Autologous

Topics: Amphotericin B; Carotid Artery Diseases; Cranial Sinuses; Eye Manifestations; Gangrene; Geriatrics; Humans; Mucormycosis; Nose; Nystatin; Ophthalmoplegia; Orbit; Paranasal Sinuses; Sinus Thrombosis, Intracranial; Sinusitis

Topics: Autopsy; Gangrene; Granulomatosis with Polyangiitis; Humans; Nose; Rhinitis

Topics: Female; Gangrene; Humans; Infant; Lip; Nasal Surgical Procedures; Nose; Perineum; Rhinoplasty; Vulva; Waterhouse-Friderichsen Syndrome