title: Symmetrical peripheral gangrene due to Plasmodium falciparum malaria.
abstract: A 45-year-old man presented with a 4-day history of high-grade fever with rigours and a 2-day history of painful bluish black discolouration of extremities (acrocyanosis). He was haemodynamically stable and all peripheral pulses palpable, but the extremities were cold with gangrene involving bilateral fingers and toes. Mild splenomegaly was present on abdominal examination but rest of the physical examinations were normal. On investigating he was found to have anaemia, thrombocytopaenia with gametocytes of Plasmodium falciparum on peripheral blood smear. His blood was uncoagulable during performance of prothrombin time with a raised D-dimer. Oxygen saturation was normal and the arterial Doppler test showed reduced blood flow to the extremities. A diagnosis of complicated P. falciparum malaria with disseminated intravascular coagulation (DIC) leading to symmetrical peripheral gangrene was performed. Artemisinin combination therapy was started and heparin was given for DIC. A final line of demarcation of gangrene started forming by 12th day.
authors.affiliation: Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
authors.forename: Nasar
authors.initials: N
authors.lastname: Abdali
authors.affiliation: Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
authors.forename: Azharuddin Mohammed
authors.initials: AM
authors.lastname: Malik
authors.affiliation: Department of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
authors.forename: Athar
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.
authors.forename: Mehtab
authors.initials: M
authors.lastname: Ahmad
mesh_terms: D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000473:pathology*; D005338:Fibrin Fibrinogen Degradation Products; D005385:Fingers / Q000098:blood supply / Q000473:pathology*; D005734:Gangrene / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D016778:Malaria, Falciparum / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D014034:Toes / Q000098:blood supply / Q000473:pathology*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D