A close relative (53yrs, female, hypertensive, no history of diabetes and tobacco) was admitted in ICU for 15 days due to severe viral pneumonia/ARDS. The pneumonia is now almost cured, but the patient has developed these gangrene like dead cells on her fingers. Most likely cause is a thrombus developed in wrist due to pic line used during pneumonia treatment. The vascular surgeons took a call to not take surgical intervention at that time due to severity of lung damage and started heparin. She is out of ICU for last 1 week, but still getting fever multiple times everyday. All the blood tests for bacterial infections are coming negative. The doctors at the hospital are saying that they will wait for sometime and then probably amputate the affected area. Is there any way to heal this without surgery? Also, could gangrene be cause of fever? Edit: I have attached the image of Doppler report. Also heparin is going on for last 20 days.




A rare case Demarcated gangrene Possibly vascular Unsalvageable Get CT angiogram to prevent further damage


Emergency Doppler study shud be done bcz mostly it's due embolism and already gangrene ho Chuka hai to they have to ampute but if we get to know the site of embolism it will be better

Very sorry to say that, as gangrene has already affected the fingers a lot & vascularity is lost, it'll be impossible to prevent amputation at this stage. But as suggested by @Dr. Prof.sudhir Mehta you may proceed to avoid further detoriate the conditions & have a better healing of the stumps.

Sir give lachesis 30 bid for 3 day's and then dicide next...

Dear Dr.Manish The gangrene is already set with demarcation, it's sorry but it ll not be practically possible to save the necrosed part Get a color doppler with DCA to further investigate the extent of vessel calibtre obstruction/thrombi embolus Take your plastic surgery colleague's help to decide the line of amputation with healing stump

I agree

Very interesting.. this seems to be cryoglobulinemic vasculitis as a complication of pneumonia caused due to ?mycoplasma pneumoniae. Similar picture is seen various post viral pneumonias too, but mycoplasma remains the most common cause (20%). Antibiotics and steroids have been used for the treatment in the past. There are several case reports published regarding this. But unfortunately, all of them led to amputation.

Vry explanatory sir.. thanks alot

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May be helpful Panch Tikta Ghrita guggulu 2 tab bd Giloya Ghan Vati 2 tab bd Gandhak Rasayana 2 Tab bd Sarivadhyasav 15 ml Khadirarishta 15 ml After meals with same quantity of water. Prakashalan by Neempatra Kwath. Local Application of Panch Gun Tail.

Agreed sir

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@Dr. P. G. Shah Sir@Dr. Hemant Adhikari Sir . please Answer.

Raynuad phenomenon

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