A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene

Traditional herbal treatment induced bilateral amputation of the feet in a five-year-old child: A case report

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Bilateral gangrene usually progress to a systemic infection and death if not treated properly.

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The development of bilateral gangrene to acute limb ischemia and eventually leading to auto amputation of both feet in this patient was unusual as she did not receive any medical or surgical interventions.

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The rare occurrence of bilateral autoamputation without any underlying vascular or neurological disorders in this patient is likely caused by vasospasm and thrombosis triggered by the herbal treatments, which possibly contain ergot alkaloids, given by the traditional healer.

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This phenomenon may play a part in future considerations for performing amputation to patients with possible necrotizing fasciitis.

Introduction

Bilateral gangrene of both legs in a child is a rare condition which may lead to sepsis when improperly treated. In certain rare cases, autoamputation may occur instead. We report a case of bilateral symmetrical autoamputation of the feet following necrotizing fasciitis after a fall injury which was treated with herbal medicine in a five-year-old child.

Presentation of case

A five-year-old girl fell from a bicycle and was treated by a traditional healer by wrapping her legs with herbs and leaves. Within 24 h, the skin of both lower limbs darkened. Her vital signs show tachycardia and fever. Physical examination revealed bluish black sharp discoloration of both her lower extremities. On the 3rd day of systemic antibiotic administration, her feet, distal portion of both legs, and part of the thighs darkened progressively. The parents refused any additional intervention due to financial constraints and went back to the traditional healer. A month later, the patient returned to the hospital with both lower extremities autoamputated. The parents denied further treatment. Two months later, the patient was admitted to receive prostheses funded by the city council. Debridement of necrotic bone and soft tissue and skin grafting was performed. In the present day, the patient is in a healthy condition.

Conclusion

The rare occurrence of bilateral autoamputation without any underlying vascular or neurological disorders in this patient is likely caused by vasospasm and thrombosis induced by the herbal treatments which prevent the systemic spread of infection.

Impending gangrene of fingers by constriction bands of mother's hair mistaken as pernio by parents: A case series of 10 infants

BACKGROUND

Long harsh winter in Kashmir Valley increase the incidence of pernio in children so much that common people consider every hand swelling as pernio.

METHODS

10 Infants over two years were brought to our hospital as cases of pernio involving fingers.

RESULTS

All the infants came out to be cases of impending gangrene due to mother's hair as constriction bands around fingers.

CONCLUSION

Impending gangrene of fingers in infants due to mother hair as constriction band is very rare. However its symptoms overlap with symptoms of peripheral cold injuries and can be easily mistaken for each other by people.

Idiopathic unilateral lower limb gangrene in a neonate

We are reporting a very unusual case of unilateral lower limb gangrene in 12 days neonate, who was brought to us with bluish discoloration of left foot with gangrene of toes. A negative sepsis screen, normal Doppler study, normal magnetic resonance angiography and absence of evidence of hypercoagulable state prompted us to make the diagnosis of idiopathic unilateral lower limb gangrene in this newborn. Because of the rarity we are reporting this case with vide review of literature.