Symmetrical peripheral gangrene and extremity amputations

Abstract

A B S T R A C TSymmetrical peripheral gangrene (SPG) is a rare syndrome. It is characterized by bilateral distal ischemia leading to gangrene, in the absence of major vascular occlusive disease. It is considered a cutaneous marker of disseminated intravascular coagulation, and more than half of the patients who survive require amputation of the affected limb(s). The etio-pathogenesis of SPG is not well understood, but the hallmark is the occurrence of microcirculatory failure. We present two patients with SPG. The aim of this report is to sensitize and to help make the diagnosis easier for the clinician. Patients who are identifi ed to be at risk require frequent observation and examination of the appearance of their distal extremities, nose, and ears. No treatment is universally effective. It should be individualized according to the underlying disease and patient's general condition. The guiding principle is prompt identifi cation and reduction or removal of aggravating factors.

Symmetrical peripheral gangrene in a child following severe malaria with concomitant sepsis

“…In Nigeria, Ejagwulu reported a 5 year old child with auto amputation of distal third of both legs and amputation stumps on the 2 nd to 4 th digits following complicated malaria with DIC( thrombocytopenia, prolonged bleeding and clotting time) and shock. 5 Fowotade et al in Ibadan reported the occurrence of purpura fulminans in two infants, both of whom had associated features of DIC in settings of severe plasmodium falciparum hyperparasitaemia. [7] Purpura fulminans is a close differential of SPG which is characterised by DIC, shock, purpuric lesions and gangrene whereas SPG is basically characterised by tissue necrosis in distal limbs which ascends proximally and is symmetrical.…”

“…Many reported cases resulted in different forms of disabling outcomes, with many requiring differing degrees of amputation. 3,5,6 It is usually unexpected and comes up suddenly with significant psychological impact on the family. Many of the cases of SPG reported are due to several different systemic illnesses, [10][11][12] with fewer cases resulting from malaria.…”

“…This has resulted in amputations of part or whole limbs in some reports. 5,11,19 Autoamputation is a very common complication, seen in as high as 80% of survivors. Features of purpuric fulminans (purpuric patches with necrosis of the skin) and shock are common however, this was not seen in this child.…”

“…1 Sepsis and very rarely, severe plasmodium falciparum malaria are the two leading infectious conditions linked with symmetrical peripheral gangrene. [1][2][3][4][5][6] Only a few published reports have highlighted the occurrence of SPG in children with severe malaria. 5,7 Malaria remains a common disease in tropical parts of the world and children below 5 years of age are the most affected, it is also one of the leading causes of mortality among them.…”

“…[1][2][3][4][5][6] Only a few published reports have highlighted the occurrence of SPG in children with severe malaria. 5,7 Malaria remains a common disease in tropical parts of the world and children below 5 years of age are the most affected, it is also one of the leading causes of mortality among them. 8 In regions of high malaria transmission, children are more susceptible to the severe and lifethreatening forms, the commonest parasitic agent being Plasmodium falciparum.…”