Back issues No.2 - 1996 / Case Report  

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Symmetrical Peripheral Gangrene of Sudden Onset-A Paraneoplastic Syndrome?
Shih-Tsung Hsu, Yu-Yun Lee, Ming-Fei Liu
Dermatol Sinica 14: 82-88, 1996

Symmetrical acral ischemia or gangrene of precipitous onset is rather uncommon and usually is seen in the setting of disseminated intravascular coagulation, sepsis, purpura fulminans, low cardiac output state, collagen vascular disease or antiphospholipid syndrome. Rarely, it may be the presenting manifestation of malignancy or heralds its recurrence or metastasis. We report a 58 year-old man with history of nasopharyngeal carcinoma presented with symmetrical Raynaud's phenomenon of sudden onset which progressed rapidly to acral gangrene in a month. Thorough laboratory tests were either within normal limits or negative except for angiography of the lower extremities which revealed patent proximal arteries and abrupt occlusion of the arteries above both ankles with collaterals. The acral gangrene eventually stabilized in 3 weeks after the feet and all fingertips became gangrenous. Bilateral B-K amputation was performed. By exclusion of other possible causes, it was tempting to conskder the underlying malignancy as the cause for gangrene in the present case. However, the relationship could not be established because there was no evidence of recurrence of the nasopharyngeal carcinoma up to one year after the onset of gangrene. The relationship of symmetrical peripheral gangrene to malignancy, and the postulated pathogenetic mechanisms are discussed.

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