Peripheral gangrene in Plasmodium vivax malaria: a rare manifestation

Arora, Neha; Gogna, Arun; Puri, Karan

doi:10.1177/0049475512472440

Cited by 5 publications

(5 citation statements)

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“…We report a case of isolated P. vivax malaria presenting with DIC manifesting as SPG. This case is unusual because DIC and SPG have been reported extremely rarely in the literature in association with isolated P. vivax malaria [5–7]. Amputations were required in all reported cases to date, however, in the present case, our patient recovered completely with antimalarial and conservative treatment emphasizing the role of early diagnosis and initiation of treatment.…”

Section: Introductionmentioning

confidence: 58%

“…However, there have been very few reports of an association of SPG with isolated P. vivax malaria infection. Arora et al [5] reported the index case of malaria with isolated P. vivax infection complicated by SPG involving bilateral hands and feet. Two other cases [6, 7] were reported of patients presenting with similar complications later.…”

Section: Discussionmentioning

confidence: 99%

“…Intriguingly all case reports of SPG in P. vivax have been from India [5–7]. Whether there are genetic factors (host related or pathogen related) or environmental issues at play can be speculated.…”

Section: Discussionmentioning

confidence: 99%

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Disseminated intravascular coagulation presenting as symmetrical peripheral gangrene: a case report

et al. 2019

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Introduction Plasmodium vivax was traditionally thought to be benign; however, nowadays it presents with a myriad of systemic complications like cerebral malaria, acute respiratory distress syndrome, acute kidney injury, acute pancreatitis, hepatic dysfunction, and disseminated intravascular coagulation, which were earlier attributed only to Plasmodium falciparum malaria. Here we report a case of a middle-aged man who presented with disseminated intravascular coagulation manifesting as symmetrical peripheral gangrene. What makes this case more interesting is that the malaria isolated was Plasmodium vivax instead of Plasmodium falciparum . Such findings were previously reported, but this is the first case where the patient was managed conservatively with antimalarial drugs without the need for amputation, which focuses on the very important role of early diagnosis and timely management. Case presentation A 44-year-old Indian man from north India presented with history of fever of 2 days’ duration with severely painful cold extremities. No pulse could be recorded on examination. A diagnosis of symmetrical peripheral gangrene was made. During the etiological evaluation, Plasmodium vivax malaria was found leading to disseminated intravascular coagulation causing this complication. He was started on artesunate and lumefantrine combination therapy and he recovered completely without the requirement of amputation. Conclusion This case highlights the non-benign nature of Plasmodium vivax and its emerging complications. Also it correlates symmetrical peripheral gangrene with Plasmodium vivax malaria. It also emphasizes the importance of timely diagnosis and intervention to reduce mortality and morbidity.

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Section: Introductionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Disseminated intravascular coagulation presenting as symmetrical peripheral gangrene: a case report

et al. 2019

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“…[14] Autopsy often reveals thrombi concentrated in the small vessels and not the large vessels. [4,5,8,18] No treatment is universally satisfactory. Rather, treatment should be guided by the underlying disease and the patient's general condition.…”

Section: Discussionmentioning

confidence: 99%

Symmetrical peripheral gangrene and extremity amputations

Ejagwulu¹,

Ibrahim²

2014

Ann Nigerian Med

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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.

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“…[1] With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported mainly from India. [2345] A few such cases or complications are also reported in Plasmodium vivax [4] and mixed[5] malaria also. Exact pathogenesis could not be ascertained.…”

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confidence: 99%

Gangrene in malaria revisited

Shubhakaran

2018

Trop Parasitol

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Peripheral gangrene in Plasmodium vivax malaria: a rare manifestation

Cited by 5 publications

References 8 publications

Disseminated intravascular coagulation presenting as symmetrical peripheral gangrene: a case report

Disseminated intravascular coagulation presenting as symmetrical peripheral gangrene: a case report

Symmetrical peripheral gangrene and extremity amputations

Gangrene in malaria revisited

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