A Case Report of Severe Malaria Due to Plasmodium falciparum Malaria Complicated by Symmetrical Peripheral Gangrene (SPG) at the Matlaboul Fawzaini National Hospital Center, Touba, Senegal

Abstract

Malaria remains a major public health problem worldwide, particularly in Africa. Symmetrical Peripheral Gangrene (SPG) is a distal ischemic lesion affecting at least two extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. Its association with malaria is rare, with approximately 27 cases reported worldwide, mostly in Asia. A 15-year-old male student with no known medical history was admitted to the Department of Medicine and Medical Specialties at Matlaboul Fawzaini National Hospital Center in Touba, presenting with a seven-day history of fever, generalized pain, vomiting, and jaundice. The initial clinical examination showed flu-like symptoms, prostration, systemic inflammatory response, hepatomegaly with a soft, regular lower border, non-cholestatic jaundice, anemia, and bilateral acrocyanosis with necrosis of the right foot's last three toes and the left foot's last four toes. Paraclinical investigations showed microcytic anemia at 6.9 mg/dL, a positive thick blood smear with a parasite density of 81,818 p/µL, negative blood cultures, and negative HIV, HBV serologies, and ANCA tests. The diagnosis of severe malaria due to Plasmodium falciparum associated with symmetrical peripheral gangrene was confirmed. The patient showed good clinical improvement under injectable artesunate followed by Artemether + Lumefantrine and symptomatic treatment for seven days. Symmetrical Peripheral Gangrene (SPG) is a very rare and severe clinical entity in the context of severe P. falciparum malaria. In malaria-endemic areas, it is poorly recognized and often attributed to other more common causes. Prompt management, including correction of tissue hypoperfusion and effective etiological treatment, can improve prognosis.