No abstract

In many parts of the East African region malaria is endemic, while in other parts it is hyper-endemic.While all the four species of the plasmodium parasite (vivax, ovale, malaria& falciparum), are prevalent in E Africa, it is the Plasmodium falciparum that is most aggressive and rampant. In this region malaria is still by far among the top three disease burdens accounting for high morbidity and mortality rates across all age groups. Whereas there are many complications associated with severe malaria, peripheral gangrene leading to amputation of limbs is so rare and unbelievable. The following is a summarized report of two cases with bilateral peripheral gangrene seen at Butare University Teaching Hospital, following severe malaria between August and October 2015. In both cases several investigations were carried out to rule out other possible causes of limb ischemia and gangrene.Key words: Peripheral gangrene; Plasmodium falciparum parasitaemia; Amputation Case 1 N.S was a 30 year old male who was first admitted at a District hospital with a febrile illness, two weeks prior to transfer to Butare University Teaching Hospital. The reason for transfer was the development of gangrene of both feet. The referral notes indicate that he was admitted at the district hospital with a high fever, with temperatures between 38 -40 degrees Celsius. The blood film showed Plasmodium falciparum malaria (+++) scizont forms. While still on treatment with coartem, his hemoglobin fell to 5mg/dl and was given blood transfusion. A few days later he developed pain and numbness of the feet. These latter symptoms became progressive even when fever subsided. He was referred on the tenth day from the District hospital when his feet had developed a dark discoloration.At Butare U.T.H, the main complaint was darkening, drying, and numbness of his feet. Prior to this febrile illness, he had been in good health, with no history suggestive of diabetes mellitus, cardiovascular disease, or any claudication. He had never smoked cigarettes, and there was no history of trauma. He was not febrile but had dry gangrene of both feet. The popliteal and femoral pulses were of good volume.The following investigations were done: