Dopamine-Associated Symmetric Peripheral Gangrene

Symmetric peripheral gangrene (SPG) presents acutely as symmetric acral necrosis without large vessel obstruction or vasculitis.¹ While relatively rare, this syndrome has been well described in the critical care literature, mainly in the context of septic shock, disseminated intravascular coagulation (DIC), and as an uncommon presentation of purpura fulminans. Vasopressors have been implicated directly or as a contributory cause in many cases.¹

Dermatologists often receive referrals from the intensive care unit, frequently for the evaluation of purpura or necrosis in the setting of septic shock and DIC.² We present 2 cases of dopamine hydrochloride— associated SPG seen over the course of 9 months.

Report of Cases. Case 1.  A 65-year-old white man with recurrent metastatic transitional cell carcinoma of the bladder presented with vomiting, diarrhea, and a 7.6-kg weight loss. He had received chemotherapy consisting of cisplatin, sodium methotrexate, and vincristine sulfate prior to admission.