Symmetrical peripheral gangrene with Plasmodium falciparum malaria

Abstract

Symmetric peripheral gangrene is rare and relatively uncommon complication of malaria. We report a case of a 50-year-old male who survived Plasmodium falciparum infection with disseminated intravascular coagulation. Symmetric peripheral gangrene in our case, which ultimately required amputation of the toes, was most likely due to interaction between parasitic factors and host factors.

Symmetrical peripheral gangrene and extremity amputations

“…The parasitized erythrocytes remain in the microcirculation by a molecular interaction with endothelial receptors, mainly vascular cell adhesion molecule I, intercellular adhesion molecule I, and histidine-rich protein. [7] The sequestration of parasitized erythrocytes due to the decreased deformability of red cells and/or adherence of infected red cells to microvascular endothelium is thought to initiate microcirculatory occlusion in malaria. [7] Elevated levels of fibrin/fibrinogen degradation products reflecting the ongoing fibrinolysis have been documented, even in uncomplicated falciparum malaria.…”

“…[7] The sequestration of parasitized erythrocytes due to the decreased deformability of red cells and/or adherence of infected red cells to microvascular endothelium is thought to initiate microcirculatory occlusion in malaria. [7] Elevated levels of fibrin/fibrinogen degradation products reflecting the ongoing fibrinolysis have been documented, even in uncomplicated falciparum malaria. [14] SPG can also occur as a complication of ergotism, measles, protein C or S or antithrombin III deficiency, and malignancy.…”

“…More than half of the patients who survive require amputation of the affected limb. [7,8] Symmetrical peripheral gangrene is a rare syndrome. A recent literature search revealed less than 100 cases.…”

Symmetrical peripheral gangrene: A rare complication of plasmodium falciparum malaria

“…Till date 25 cases of SPG complicating malaria have been documented in literature and latest being reported by Gupta et al (2013). [ 2 ] In P. falciparum infections, membrane protuberances appear on the erythrocyte's surface 12-15 h after the cell's invasion. These “knobs” extrude a erythrocyte membrane adhesive protein that mediates attachment to receptors on venular and capillary endothelium predominantly via intercellular adhesion molecule 1, an event termed cytoadherence.…”

“…Literature survey has documented 25 cases of SPG caused by malaria. [ 1 2 ] We report this rare entity in a 17-year-old boy presented with complicated malaria.…”