Symmetrical peripheral gangrene complicating Klebsiella pneumoniae sepsis associated with antiphospholipid antibodies

We have encountered a rare case of symmetrical peripheral gangrene1–5 complicating Klebsiella pneumoniae sepsis associated with antiphospholipid antibodies. A 72 year old woman was admitted to our hospital with fever and symmetrical gangrene of both fingers and toes. She had been well until she began to suffer from fever and pain in the abdomen 3 days before admission. She then attended a local hospital and underwent an abdominal computed tomography scan that showed a liver abscess. Culture of blood and ultrasonography guided aspirates disclosed Klebsiella pneumoniae . The day before admission she had deep-bluish discolouration of both fingers and toes, and she was transferred to our hospital. On admission, most of her fingers and toes already showed gangrenous changes (fig 1A), but the pulse in the bilateral radial, ulnar, and …