Upper limb gangrene following intramuscular diclofenac: a rare side effect
A 56-year-old male patient presented to the emergency department of this hospital with the complaint of severe pain and blackish discolouration of the left hand and forearm. The patient gave history of attending one local hospital 2 days before coming to our hospital, with the complaint of mild pain on the left side of the abdomen for which an injection of diclofenac was given intramuscuarly in the left deltoid region. Soon after getting the injection, the patient developed severe pain in his left hand. He also noticed some pale discolouration of his hand. Gradually the whole of the left hand and part of the forearm turned blackish in colour (Fig. ). The patient had a known case of left renal calculi and had earlier undergone ureteroscopic retrieval of the calculi. The patient also had a Double J stent placed in situ, following stone retrieval.\nUrgent Doppler scanning of the upper limb vessels was done, which revealed complete occlussion of both the radial and ulnar arteries on the injected side. Injection of heparin was started immediately, but the patient's limb could not be salvaged. Below elbow amputation was done for the patient. There were no signs of arteriopathy in any other parts of the body as evidenced by clinical and Doppler study. All routine blood investigations, including lipid profile and serum CK levels, were found to be within normal limits. Antinuclear antibodies, C-reactive proteins and rheumatoid factors were all within normal ranges.