title: Successful resolution of symmetrical peripheral gangrene after severe acute pancreatitis: a case report.
abstract: BACKGROUND
  Symmetrical peripheral gangrene is an uncommon but devastating complication in critically ill patients, and it has a high mortality. It is seen in a wide variety of medical conditions, presenting as symmetrical gangrene of two or more extremities without large blood vessel obstruction.
  
  
  METHODS
  We report a case of a 44-year-old Chinese man who was diagnosed with alcohol-related severe acute pancreatitis and presented with systemic inflammatory response syndrome and intractable vomiting. On the fourth day of admission, the patient developed cyanosis and gangrene of the fingers bilaterally. His cyanosis and gangrene did not resolve despite tapering of the vasopressor treatment. Gradually, his digital gangrene improved after administration of anti-platelet medication and pentoxifylline.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first case report of symmetrical peripheral gangrene occurring after acute pancreatitis with successful resolution. We highlight the importance of prompt and aggressive fluid resuscitation and consideration of multiple treatment options to prevent a hypovolemic state caused by acute pancreatitis.
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. ericliao0217@gmail.com.
authors.forename: Chen-Yi
authors.initials: CY
authors.lastname: Liao
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. sghung@hotmail.com.
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. beetle95@gmail.com.
authors.forename: Cheng-Hui
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. ndmcndmcndmc@gmail.com.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. lancer0106@yahoo.com.tw.
authors.forename: Mei-Yu
authors.initials: MY
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. benrjbridge@gmail.com.
authors.forename: Ren-Jy
authors.initials: RJ
authors.lastname: Ben
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. wuhsienku@gmail.com.
authors.forename: Wu-Hsien
authors.initials: WH
authors.lastname: Kuo
authors.affiliation: Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. tsgh11@gmail.com.
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D005385:Fingers / Q000473:pathology; D005734:Gangrene / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000150:complications*; D010431:Pentoxifylline / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D010431:Pentoxifylline