Asymmetrical digital gangrene from standard-dose noradrenaline: A rare case report

Noradrenaline is a first-line vasopressor commonly used in critically ill patients with circulatory shock, but peripheral gangrene remains a rare and serious complication, typically presenting as symmetrical bilateral involvement of the extremities. We report a rare case of a 34-year-old previously healthy male who developed asymmetrical peripheral gangrene following standard-dose noradrenaline therapy for septic shock secondary to Streptococcus pneumoniae pneumonia. The patient exhibited an unusual pattern with three fingers affected on the right hand and one on the left hand, while the lower extremities remained completely normal. Despite receiving therapeutic noradrenaline doses of 0.08-0.11 µg/kg/min and having no traditional risk factors, the patient developed severe gangrenous changes requiring autoamputation of affected digits. Following immediate discontinuation of noradrenaline and initiation of anticoagulation therapy with supportive care, the patient recovered from septic shock and was discharged after 32 days with satisfactory functional recovery. This case highlights the unpredictable nature of vasopressor-induced complications and emphasizes the critical need for vigilant monitoring of peripheral perfusion in all patients receiving vasopressor therapy.