Symmetrical Peripheral Gangrene in Disseminated Tuberculosis

Abstract

We report the case of a 66-year-old man who developed a symmetrical peripheral gangrene (SPG) on both feet during disseminated miliary tuberculosis. Mycobacterium tuberculosis was not only isolated from sputum, gastric juice, and urine, but also from a blood culture. Since a disseminated intravascular coagulopathy was very likely to be excluded, it is possible that the SPG was due to embolization of arterioles by the tubercle bacilli. The literature of SPG is reviewed and the different possible pathogenic mechanisms of SPG, such as hypoxemia, vasoconstriction, primary endothelial damage, and vascular obstruction, are discussed. SPG is another cutaneous manifestation of disseminated tuberculosis.

Digital Gangrene in Disseminated Tuberculosis: A Rare Presentation

“…Itin, et al (4) described symmetrical peripheral gangrene in a patient with disseminated tuberculosis. As mycobacterium tuberculosis was isolated from the blood culture, it was thought that symmetrical peripheral gangrene resulted from embolisation of arterioles by the tubercular bacilli.…”

Symmetrical peripheral gangrene

“…falciparum, [17,18] Mycobacterium tuberculosis, [19] Rubeola virus, and Varicella zoster virus [1,15] have been implicated as the causative agents of SPG. Viral gastroenteritis has also been described as a causative factor of SPG.…”

Digital gangrene in spinal tuberculosis

“…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]. Gangrene secondary to TB has been reported at various sites of the body such as scrotum, penis, small intestines, and retina [16][17][18].…”