Cardiogenic Shock and Symmetrical Peripheral Gangrene in Relapsed Follicular Lymphoma: A Case Report With Bordetella bronchiseptica Co-infection.

We present a case of a 53-year-old man with longstanding relapsed follicular lymphoma who was admitted with a febrile respiratory illness following close contact with multiple dogs and suffered a cardiac arrest on the first day of hospitalization. He was successfully resuscitated but developed an acute myocardial infarction with severely reduced ventricular function and cardiogenic shock requiring vasopressor support. The resulting peripheral hypoperfusion produced symmetrical dry gangrene of all ten digits and both feet, requiring multiple digital and bilateral foot amputations. Respiratory cultures obtained after antibiotics were held, once the patient was clinically stable, grew Bordetella bronchiseptica and Haemophilus parainfluenzae, organisms likely colonizing the respiratory tract from the time of admission. Targeted therapy with levofloxacin was completed, the patient was extubated, cardiac function recovered fully, and he was discharged with plans to resume lymphoma-directed treatment. This case highlights the vulnerability of patients with untreated relapsed hematologic malignancy to atypical zoonotic respiratory pathogens and illustrates the vasopressor-driven mechanism of symmetrical peripheral gangrene in the setting of post-arrest cardiogenic shock.