Ischemic necrosis of the tongue in surgical patients with septic shock: a case report

Abstract

BackgroundAs the tongue is a well-vascularized organ, ischemic necrosis of the tongue is a rare disease entity. Critically ill patients with profound shock may experience end-organ hypoperfusion, which might result in tongue necrosis. However, to our best knowledge, there are no reports regarding ischemic necrosis of the tongue in surgical patients with septic shock.Case presentationTwo patients recently developed ischemic necrosis of the tongue in our surgical intensive care unit. Both patients had undergone emergent surgery for ischemic enteritis and developed postoperative septic shock. The first patient responded to critical treatment with a short period of circulatory shock, and the delivered dose of the vasopressor seemed to be acceptable. In contrast, the second patient developed postoperative refractory shock, and high-dose vasopressor treatment was required to maintain adequate tissue perfusion. Both patients developed ischemic necrosis of the tongue and died shortly after its emergence, despite vigorous resuscitation.ConclusionsWe suggest that ischemic necrosis of the tongue is an under-reported manifestation of any type of circulatory shock, which may have a complex pathogenic mechanism. Clinicians should be aware of the possibility of ischemic necrosis of the tongue in patients with circulatory shock, even if the patient exhibits clinical improvement, as this awareness may facilitate estimation of their prognosis and preparation for clinical deterioration.

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient

“…9 Furthermore, already various non-COVID-19 types of septic and cardiogenic shock have been associated with ischemia and even necrosis of the tongue. 10 – 12 …”

A nyelv necrosisa mint az arteritis temporalis szokatlan manifesztációja

“…A további kivizsgálás a kezeléssel párhuzamosan folytatható. Differenciáldiagnosztika szempontjából a nyelv vérellátását károsító egyéb kórképek jönnek számításba, például elhúzódó kardiogén vagy szeptikus sokk, essentialis thrombocytosis, disszeminált intravascularis coagulatio [14,15].…”

“…A más intéz-ményben végzett sürgősségi vizsgálatok során -mellkasröntgenen, koponya CT-n -kóros nem volt. Laboratóri-umi leleteiből magas C-reaktív protein (196 mg/L) és Westergreen-érték (70 mm/h), leukocytosis (11,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)5 G/L) emelhető ki. Sürgősséggel elvégzett anti-DNS-, anti-MPO-, anti-PR3-, anti-GBM-antitest-vizsgálatok és antifoszfolipidantitest-vizsgálatok negatívak lettek.…”

OUP accepted manuscript

“…Tongue necrosis has most frequently been associated with giant cell arthritis [1–5], as seen in temporal arthritis, often diagnosed by a high erythrocyte sedimentation rate [1, 2, 6, 7]. It may also occur with cardiogenic shock [1], leading to end-organ hypoperfusion.…”

“…It may also occur with cardiogenic shock [1], leading to end-organ hypoperfusion. Vascular compromise may occur with use of vasoconstrictors [2, 3] such as vasopressin, especially when a high dose or continuous infusion is required to maintain blood pressure [2, 5].…”