Systemic Vasospasms Induced by Vasopressor Therapy Resulting in Diffuse Tissue Necrosis and Death: A Case Report and Review of the Literature

Division

Central and West Texas

Hospital

Las Palmas Medical Center

Document Type

Case Report

Publication Date

4-25-2021

Keywords

vasoconstrictor agents, vasopressor, septic shock, necrosis, vasospasm

Disciplines

Cardiology | Cardiovascular Diseases | Chemicals and Drugs | Critical Care

Abstract

This is a case report involving a fatal presentation of systemic necrosis caused as a reaction to vasopressor therapy in a 71-year-old male treated for septic shock in the intensive care setting. Complete necrosis of the tongue and lower extremities were noted. Internal organ necrosis was also noted, which resulted in an oliguric acute kidney injury (AKI) and mesenteric ischemia. Generally associated with giant cell arteritis, ischemic necrosis of the tongue secondary to vasopressor administration has seldom been documented and is possibly underreported. Similarly, to the best of our knowledge, severe systemic vasospasms leading to death in the setting of vasopressor administration has never been documented before. There is a lack of evidence-based guidelines to follow in critically ill patients showing signs of vasospasms and/or tissue necrosis while requiring vasopressor intervention. We therefore seek to provide more insight to critical care providers in identifying these sequelae, which may occur even with surprisingly low vasopressor doses. Furthermore, we describe how we weaned down the vasopressor doses in light of the tissue necrosis and with the guidance of limited available literature. We hope to provide information that will be useful in establishing guidelines and further literature for similar scenarios in the future.

Publisher or Conference

Journal of Emergency and Critical Care Medicine

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