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  • Clinical/Perinatal Neonatal Case Presentation
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Clinical Perinatal/Neonatal Case Presentation

Venous Gangrene of Lower Extremities and Staphylococcus Aureus Sepsis

Journal of Perinatology volume 21, pages 136–140 (2001)Cite this article

Abstract

This is a study of the venous gangrene of lower extremities and Staphylococcus aureus sepsis. We report on a premature infant who developed phlegmasia cerulea dolens (PCD) in both lower extremities in association with S. aureus sepsis, resulting in gangrene of the right foot. Non-pitting edema and cyanosis of the digits of the right lower extremity were noted 48 hours after hypotension and severe shock due to S. aureus sepsis. Intravenous antibiotics, isotonic fluids, and heparin were administered. Twenty-four hours later, edema and ischemic changes of the first and fifth left toes were also noted. Doppler flow study showed flow signals in both right and left popliteal arteries. However, there were no Doppler signals in neither right nor left popliteal vein. Emergency fasciotomies were performed on both lower limbs. The progression of the gangrene was limited to the right foot. There was complete resolution of PCD in both lower extremities. To the best of our knowledge, the association of S. aureus sepsis with PCD and venous gangrene in an infant has not been reported previously. This case illustrates the need for early recognition of PCD and aggressive intervention.

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References

  1. Haimovici H Gangrene of the extremities of venous origin. Review of literature with case reports Circulation 1950 1 225–40

    Article  CAS  Google Scholar 

  2. Gregoire R La phlebite bleue (phlegmasia caerulea dolens). Presse Med 1938 46 1313–5

    Google Scholar 

  3. Brockman SK, Vasko JS Phlegmasia cerulea dolens Surg Gynecol Obstet 1965 121 1347–55

    CAS  PubMed  Google Scholar 

  4. Brockman SK, Vasko JS The pathologic physiology of phlegmasia cerulea dolens Surgery 1996 59 997–1007

    Google Scholar 

  5. Qvarfordt P, Eklof B, Ohlin P Intramuscular pressure in lower leg in deep vein thrombosis and phlegmasia cerulea dolens Ann Surg 1983 197 450–3

    Article  CAS  Google Scholar 

  6. Saffle JR, Maxwell JG, Jolley SG, Lawrence PF Measurement of intramuscular pressure in the management of massive venous occlusion Surgery 1981 89 394–7

    CAS  PubMed  Google Scholar 

  7. Snyder MA, Adams JT, Schwartz SI Hemodynamics of phlegmasia cerulea dolens Surg Gynecol Obstet 1967 125 342–6

    Google Scholar 

  8. Weaver FA, Meacham PW, Adkins RB, Dean RH Phlegmasia cerulea dolens: therapeutic considerations South Med J 1988 81 306–12

    Article  CAS  Google Scholar 

  9. Whitesides TE, Haney TC, Morimoto K, et al Tissue pressure measurements. A determinant for the need of fasciotomy Clin Orthop 1975 113 143

    Article  Google Scholar 

  10. Snyder MA, Adams JT, Schwartz SI Hemodynamics of phlegmasia cerulea dolens Surgery 1996 59 997–1007

    Google Scholar 

  11. Hirschman JV Ischaemic forms of acute venous thrombosis Arch Dermatol 1987 123 933–6

    Article  Google Scholar 

  12. Elliot MS, Immelman EJ, Jeffrey P, et al The role of thrombolytic therapy in the treatment of phlegmasia caerulea dolens Br J Surg 179 66 422–4

  13. Fitton AR, Dickson DA, Shortland G, et al Peripheral gangrene associated with fulminating meningiococcal septicaemia J Hand Surg 1997 22B 408–10

    Article  Google Scholar 

  14. Michael Shurr MD, Sandra Engelhardt MD, Richard Helgerson MD Limb salvage for streptococcal gangrene of the extremity AM J Surg 1998 175(3)213–7

    Article  Google Scholar 

  15. Espinoza R, Andersen M, Nervi B, Rosemberg H Septic phlebitis: origin of severe septic condition Rev Med Child 1998 126(2)195–8

    CAS  Google Scholar 

  16. Lowy F Medical progress: Staphylococcus aureus infections N Engl J Med 1998 39(8)520–32

    Article  Google Scholar 

  17. Artenstein MS, Madoff MA, Weinstein L Studies of biological activity of purified staphylococcal alpha toxin: I. The effect of alpha-toxin on cells in tissue culture Yale J Biol Med 1963 35 373–81

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Weaver FA, Meacham PW, Adkins RB Phlegmasia cerulea dolens: therapeutic considerations South Med J 1988 81 306–12

    Article  CAS  Google Scholar 

  19. Goldhaber SZ, Buring JE, Lipmick RJ, et al Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis Am J Med 1984 76 393–7

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Pediatrics, Louisiana State University Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, 71130-3932, LA, USA

    Hassan Ibrahim MD, Richard Krouskop MD, Majed Jeroudi MD, Catrell McCulloch MD, MF, Haroon Parupia MD & Ramasubbareddy Dhanireddy MD

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  1. Hassan Ibrahim MD
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  2. Richard Krouskop MD
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  3. Majed Jeroudi MD
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  4. Catrell McCulloch MD, MF
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  5. Haroon Parupia MD
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  6. Ramasubbareddy Dhanireddy MD
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Ibrahim, H., Krouskop, R., Jeroudi, M. et al. Venous Gangrene of Lower Extremities and Staphylococcus Aureus Sepsis. J Perinatol 21, 136–140 (2001). https://doi.org/10.1038/sj.jp.7200496

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