Acral necrosis

Acral necrosis
A hand with acral gangrene due to plague

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acral necrosis is a symptom common in bubonic plague.

Historical Perspective

The striking black discoloration of skin and tissue, primarily on the extremities, is commonly thought to have given rise to the name "Black Death," associated both with the disease and the pandemic which occurred in the 14th century. The term in fact came from the figural sense of "black", that is glum, lugubrious or dreadful.

Pathophysiology

Clotting and bleeding beneath the skin causes an area of hemorrhage, the presence of red blood cells lying outside of capillaries, into the skin and subcutaneous tissue. In isolation, this is called an ecchymosis or bruise and may be the result of injury or illness. However, acral necrosis occurs when blood supply is disrupted for prolonged periods, blackening and damaging the affected area and surrounding tissue.

Gross Pathology

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers

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  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers

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  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers

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  Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids

Causes

Causes in Alphabetical Order

• Antiphospholipid Antibody Syndrome
• Arteriovenous fistula
• Atherosclerosis
• Biological warefare agents
• Bleomycin
• Borrelia infection
• Bubonic plague
• Calcific azotemic arteriopathy
• Capecitabine
• Carbon monoxide poisoning
• Chronic renal failure
• Coumarin
• Cryofibrinogenemia
• Cutaneous polyarteritis nodosa
• Deep vein thrombosis
• Diabetes mellitus
• Doxorubicin
• Erythromelagia
• Fasciitis
• Frostbite
• Gemcitabine
• Heparin induced thrombocytopenia
• Hypereosinophilic syndrome
• Panniculitis
• Peripheral vascular disease
• Pneumonic plague
• Polyangiitis overlap syndrome
• Primary hyperoxaluria type 1
• Purpura fulminans
• Quinine
• Raynaud's disease
• Scleroderma
• Sharp syndrome
• Sternotrophomonas maltophilia
• T-cell lymphoma
• Vasculitis
• Vinblastine
• Vincristine
• Waldenstrom's macroglobulinemia
• Warfarin

Natural History, Complications and Prognosis

Untreated cases can lead to death.

Treatment

With appropriate medical treatment, areas with Acral necrosis may be successfully restored to function.