{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T16:21:31Z","timestamp":1771950091716,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,7,17]],"date-time":"2019-07-17T00:00:00Z","timestamp":1563321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.<\/jats:p>","DOI":"10.3390\/medicina55070383","type":"journal-article","created":{"date-parts":[[2019,7,17]],"date-time":"2019-07-17T02:44:03Z","timestamp":1563331443000},"page":"383","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Symmetrical Peripheral Gangrene Associated with Low Output Cardiac Failure"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8324-2827","authenticated-orcid":false,"given":"Sijan","family":"Basnet","sequence":"first","affiliation":[{"name":"Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Rajagopalan","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashmi","family":"Dhital","sequence":"additional","affiliation":[{"name":"Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ataul","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1136\/bmj.2.1592.8","article-title":"Severe symmetrical gangrene of the extremities","volume":"2","author":"Hutchinson","year":"1891","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s12262-012-0576-7","article-title":"Symmetrical peripheral gangrene-a case report and brief review","volume":"75","author":"Shenoy","year":"2013","journal-title":"Indian J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"244","DOI":"10.4103\/0378-6323.77481","article-title":"Symmetrical peripheral gangrene","volume":"77","author":"Ghosh","year":"2011","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_4","first-page":"2","article-title":"Symmetrical Peripheral Gangrene","volume":"34","author":"Sharma","year":"2004","journal-title":"Trop. Dr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1001\/archsurg.1974.01350300022006","article-title":"Symmetrical peripheral gangrene","volume":"108","author":"Goodwin","year":"1974","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1056\/NEJM195603222541207","article-title":"Symmetrical peripheral gangrene in myocardial infarction; report of a case","volume":"254","author":"Caserta","year":"1956","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1136\/hrt.13.1.68","article-title":"Peripheral gangrene in myocardial infarction","volume":"13","author":"Swan","year":"1951","journal-title":"Br. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1136\/bmj.2.5267.1615","article-title":"Peripheral Gangrene in a Case of Myocardial Infarction","volume":"2","author":"Cohen","year":"1961","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"754","DOI":"10.4103\/0971-9784.191546","article-title":"Symmetrical peripheral gangrene associated with cardiac surgery","volume":"19","author":"Rawat","year":"2016","journal-title":"Ann. Card. Anaesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/hrt.10.3.191","article-title":"Incipient symmetrical peripheral gangrene complicating paroxysmal tachycardia","volume":"10","author":"Abrahams","year":"1948","journal-title":"Br. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1590\/abd1806-4841.20165061","article-title":"Symmetrical peripheral gangrene complicating ventricular pseudoaneurysm: A report of an unusual case and a brief review of the literature","volume":"91","author":"Ghosh","year":"2016","journal-title":"An. Bras. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1136\/bmj.1.4070.15","article-title":"Symmetrical Gangrene in Cardiac Failure","volume":"1","author":"Perry","year":"1939","journal-title":"BMJ"},{"key":"ref_13","first-page":"510","article-title":"Restribution of blood in heart failure","volume":"17","author":"Fishberg","year":"1938","journal-title":"J. Clin. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1113\/jphysiol.1957.sp005776","article-title":"Evidence for critical closure of digital resistance vessels with reduced transmural pressure and passive dilatation with increased venous pressure","volume":"136","author":"Roddie","year":"1957","journal-title":"J. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ruffin, N., Vasa, C.V., Breakstone, S., and Axman, W. (2018). Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock. BMJ Case Rep., 2018.","DOI":"10.1136\/bcr-2017-223602"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.jaad.2007.07.039","article-title":"Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic","volume":"57","author":"Davis","year":"2007","journal-title":"J. Am. Acad. 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