The protective effect of brachial plexus palsy in purpura fulminans

Sepsis-induced digital ischaemia in a professional pianist, in the absence of vasopressors

“…Although this case meets the definitions of overwhelming postsplenectomy sepsis, the focus of our discussion centres on the digital ischaemic complication, which is a recognised complication of any form of sepsis. It is, however, most commonly associated with Neisseria meningitidis and S. pneumoniae 8 10 11. Pneumococcus was detected in our patient by serum PCR and urinary antigen.…”

“…There is limited understanding of the underlying pathophysiology, and we hesitate to oversimplify what is undoubtedly a complex process. Proposed mechanisms include an acute imbalance in prothrombotic and anticoagulant factors leading to microcirculatory occlusion; intense vasoconstriction secondary to natural physiological responses to shock and high-dose vasopressor administration; and endothelial damage from immune complexes 3–6 9 10 12–15. It may be that all of these occur concurrently.…”

“…Vasodilation by local sympathetic blockade has also been strongly advocated, particularly through the use of stellate ganglion anaesthesia (table 3). 3 5 10 17 Therapeutic anticoagulation precluded this technique. Instead, an axillary brachial plexus block was successfully performed on the right arm.…”