https://orcid.org/0000-0002-1165-1103
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Anuradha bishnoi, Ankur Guliani, Keshavamurthy Vinay, M Sendhil Kumaran, Lower limb purpura in setting of acute paraplegia: cutaneous clue to a catastrophic cardiac event, Postgraduate Medical Journal, Volume 95, Issue 1123, May 2019, Page 288, https://doi.org/10.1136/postgradmedj-2019-136469
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A middle-aged shopkeeper, with type II diabetes mellitus presented with purple-black skin discolouration on both lower limbs, extending from toes till upper thighs (figure 1A,B, C). He complained of sudden bilateral lower extremity weakness 9 days back, after 2 days of which, he started having dusky discolouration on his toes that had progressed proximally. Sphincter function was preserved and there was no history of smoking, preceding claudication, trauma, new drug intake or intramuscular injections. The limbs were cold, and motor activity and sensations were impaired below the knee. Bilateral popliteal and tibial arteries were non-palpable.
Electrocardiograph suggested an acute coronary syndrome. Echocardiogram revealed an apical left ventricular thrombus (18×15 mm, figure 1D). Arterial Doppler showed an acute echogenic thrombus in distal descending aorta and distending bilateral external iliac arteries (figure 1E). Non-contrast CT scan of brain was normal. Rhabdomyolysis induced acute renal failure precluded contrast-enhanced angiography. In accordance with a diagnosis of non-salvageable acute embolic limb ischaemia, amputation was performed. Unfortunately, the patient succumbed to a second myocardial infarction post-amputation.
