DIGITAL NECROSIS IN ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME VASCULOPATHY TREATED WITH RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR

Widespread digital ischemic changes and gangrene of the hands and feet is an uncommon but dramatic presentation in patients with human immun odeficiency virus (HIV) infection, We describe a patient in whom these clinical findings were associated with elevated serum endothelin leve ls, Because endothelin may affect the fibrinolytic system, we elected to treat with tissue plasminogen activator (tPA), which resulted in sa lvage of tissue of the fingers and toes, Patients with HIV infection w ith widespread ischemic necrosis and gangrene may require treatment wi th corticosteroids (in the event of possible vasculitis), thrombolytic agents (for the thrombotic component), or both, unless there are cont raindications to either.