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(A) Tumefaction with multiple discharging sinuses over right foot. (B) Histopathology showed lymphohistiocytic infiltrate and polymormps with characteristic basophilic grain surrounded by eosinophillic material (haematoxylin and eosin stain, magnification ×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Mushtaq" "autores" => array:1 [ 0 => array:2 [ "nombre" => "S." 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Lorca, E. García-Zamora, A. Ballestero" "autores" => array:3 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Lorca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "E." "apellidos" => "García-Zamora" "email" => array:1 [ 0 => "garciazamoraelena@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ballestero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Cirugía General, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Necrosis acral secundaria al uso de noradrenalina por <span class="elsevierStyleItalic">shock</span> séptico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 500 "Ancho" => 950 "Tamanyo" => 94111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 75-year-old woman weighing 60 kg was admitted to intensive care for persistent hypotension (75/60 mmHg) due to septic shock caused by a urinary tract infection. She had a history of hypertension and dyslipidemia under pharmacological control and type 2 diabetes mellitus with good glycemic control under treatment with metformin 850 mg/d. Despite intensive fluid therapy, her blood pressure remained low, and after 8 hours at a level of under 80/60 mmHg, she required the administration of high-dose noradrenaline (0.5 µg/kg/min) through a peripheral line in the left forearm. Twenty-four hours later, she developed violaceous, blackish plaques on the fingertips of her left hand that progressed proximally over the following 72 hours, forming extensive necrotic plaques on all fingers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Despite treatment with broad-spectrum antibiotics, high-dose vasoactive agents, and amputation of several phalanges, the patient died of multiorgan failure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ischemic skin necrosis due to vasoconstriction is an extremely serious and rare complication that usually affects critical patients on vasoconstrictor therapy. It occurs in patients with severe injection site vascular compromise or in association with Raynaud phenomenon and digital gangrene. Adrenaline, noradrenaline, and their derivatives have been described as potential causative agents. The pathogenic mechanism is related to high-dose administration and peripheral infusion. The incidence of ischemic skin necrosis has decreased significantly with the use of central venous accesses and catheters.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-03" "fechaAceptado" => "2019-02-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lorca J, García-Zamora E, Ballestero A. Necrosis acral secundaria al uso de noradrenalina por <span class="elsevierStyleItalic">shock</span> séptico. Actas Dermosifiliogr. 2021;112:551.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 500 "Ancho" => 950 "Tamanyo" => 94111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000006/v1_202106020933/S1578219021001451/v1_202106020933/en/main.assets" "Apartado" => array:4 [ "identificador" => "41141" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000006/v1_202106020933/S1578219021001451/v1_202106020933/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001451?idApp=UINPBA000044" ]
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