Symmetrical peripheral gangrene and tuberculosis: A rare kinship

Abstract

Symmetrical peripheral gangrene (SPG) is a rare clinical syndrome characterized by ischemic necrosis of 2 or more limbs, without involvement of large vessels. It is often associated with disseminated intravascular coagulation and septic shock. Usually caused by Gram-positive and Gram-negative organisms, tuberculosis as a cause is extremely rare. We present the case of a 46-year-old man, who initially presented with signs and symptoms suggestive of tuberculosis but later developed SPG along with septic shock after his initial visit. The case highlights the progression of this dreaded complication and touches upon recent developments in its etiology as well as pathogenesis.

Digital gangrene in spinal tuberculosis

“…Similar to our case, Bansal and Tyagi presented a case of digital gangrene in disseminated TB in a 35-year-old male [13]. Another case of symmetrical peripheral gangrene was presented by Patial et al in a 46-year-old man, who initially presented with signs and symptoms suggestive of TB but later developed symmetrical peripheral gangrene along with septic shock [14]. Itin et al described symmetrical peripheral gangrene in a patient with disseminated TB [15].…”

Acute symmetric peripheral gangrene following a long-standing Mycobacterium malmoense infection: A very rare kinship

“…According to Patial et al, 6 vasculitis can be associated with M tuberculosis infection. In our case, the tuberculosis gene expert and Fite stain results were both negative.…”

Disseminated intravascular coagulation: A devastating systemic disorder of special concern with COVID ‐19

“…Symmetrical peripheral gangrene (SPG) is gangrene of the acral parts of the body. The hypercoagulable state of DIC results in microvascular occlusion beginning distally and advancing proximally 22 . SPG manifests as fever, followed by cyanosis, pallor, and pain, and is often caused by Gram‑positive and Gram‑negative organisms, rarely tuberculosis 22,23 .…”

“…The hypercoagulable state of DIC results in microvascular occlusion beginning distally and advancing proximally 22 . SPG manifests as fever, followed by cyanosis, pallor, and pain, and is often caused by Gram‑positive and Gram‑negative organisms, rarely tuberculosis 22,23 . There is an association between cold ambient temperature and the development of gangrene, postulated to be related to increased vasospasm 21 .…”