Skin necrosis following dobutamine extravasation

Background: Dobutamine, a synthetic catecholamine with alpha-1 and beta-2 adrenergic activity, is commonly used as an inotropic agent for short-term management of heart failure. While its adverse effects are predominantly cardiovascular, cutaneous reactions, including local inflammation and rare cases of skin necrosis, can occur following extravasation. Case report: We present a case of 80-year-old woman with a history of diabetes and hypertension who developed local skin necrosis at the site of a dobutamine infusion. Admitted for cardiogenic shock, she received intravenous dobutamine via a peripheral catheter on the dorsal side of her left hand. On the third day, she developed a painful necrotic lesion with fever. The dobutamine infusion was discontinued, and treatment with systemic antibiotics and topical therapy led to complete regression within 15 days. Discussion: The Naranjo Adverse Reaction Probability Scale confirmed dobutamine as the likely trigger of necrosis (score=6). Necrosis is attributed to local α1-adrenergic stimulation leading to vasospasm, venous constriction and tissue ischemia. Risk factors for vasopressor-induced necrosis including diabetes, hypertension, and advanced age were present in our patient. Peripheral administration of vasopressors increases the risk of extravasation injuries, highlighting the importance of central venous access for such medications. Conclusion: This case underscores the importance of early recognition and management of cutaneous necrosis associated with dobutamine extravasation, particularly in patients with predisposing factors.