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Symmetrical Peripheral Gangrene Sepsis DIC — FRCA Final MCQ

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HardIntensive Care MedicineSymmetrical Peripheral Gangrene Sepsis DICFRCA Final

A 50-year-old man (ASA III) in the ICU with severe pneumonia develops bilateral hand and foot ischaemia with purpuric skin lesions despite adequate cardiac output and warm central peripheries. He is on noradrenaline 0.2 mcg/kg/min. Diagnosis is symmetric peripheral gangrene. What is the underlying mechanism?

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Correct answer: B — Raynaud phenomenon

Symmetrical peripheral gangrene (SPG) in sepsis is caused by DIC with microvascular thrombosis occluding the digital arterioles. The small vessels of the extremities (fingers, toes, nose, ears) are most vulnerable. Although noradrenaline can contribute via vasoconstriction, SPG occurs primarily from DIC-mediated microthrombosis. The purpuric skin lesions represent purpura fulminans. Management: treat the underlying sepsis (source control, antibiotics), anticoagulate with heparin (controversial in DIC with bleeding), consider prostacyclin infusion for digital perfusion, and urgent haematology input.

Reference: BSH – 2020 – DIC guidelines; SSC – 2021 – Sepsis management