Symmetrical peripheral gangrene: Unusual complication of dengue fever

Document Type : CASE REPORT


1 Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India

2 Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India

3 Department of Geriatric ICU, King George's Medical University, Lucknow, Uttar Pradesh, India


Symmetrical peripheral gangrene (SPG) is a rare clinical entity, infective, and noninfective both types of etiologies are responsible. The basic underlying pathology in SPG is being disseminated intravascular coagulation and carries a high mortality. Here, we describe a 52-year-old male with dengue fever, who developed bilateral symmetrical dry gangrene of both hand and feet. His dengue IgM antibody was positive. All the peripheral pulses of the affected limbs were palpable. Color Doppler study of upper and lower limb vessels showed normal flow. The patient was managed with intravenous fluids, low molecular weight heparin, and fresh frozen plasma. His general condition was improved within 72 h with no further progression of gangrene. Clinician should suspect the possibility of SPG while dealing a case of dengue fever presenting as peripheral gangrene.


Ghosh SK, Bandyopadhyay D. Symmetrical peripheral gangrene. Indian J Dermatol Venereol Leprol 2011;77:244-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Robboy SJ, Mihm MC, Colman RW, Minna JD. The skin in disseminated intravascular coagulation. Prospective analysis of thirty-six cases. Br J Dermatol 1973;88:221-9.  Back to cited text no. 2
Molos MA, Hall JC. Symmetrical peripheral gangrene and disseminated intravascular coagulation. Arch Dermatol 1985;121:1057-61.  Back to cited text no. 3
Modak D, Guha SK. Symmetrical peripheral gangrene: A rare complication of dengue fever. Indian J Med Sci 2012;66:292-5.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
Parmar MS. Symmetrical peripheral gangrene: A rare but dreadful complication of sepsis. CMAJ 2002;167:1037-8.  Back to cited text no. 5
Kalajian AH, Turpen KB, Donovan KO, Malone JC, Callen JP. Phenylephrine-induced microvascular occlusion syndrome in a patient with a heterozygous factor V Leiden mutation. Arch Dermatol 2007;143:1314-7.  Back to cited text no. 6
Davis MD, Dy KM, Nelson S. Presentation and outcome of purpura fulminans associated with peripheral gangrene in 12 patients at Mayo Clinic. J Am Acad Dermatol 2007;57:944-56.  Back to cited text no. 7
Avasthi R, Chaudhary SC, Singh KP, Makker JS. Symmetrical peripheral gangrene. J Assoc Physicians India 2008;56:442.  Back to cited text no. 8
Gurugama P, Garg P, Perera J, Wijewickrama A, Seneviratne SL. Dengue viral infections. Indian J Dermatol 2010;55:68-78.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
Available from: [Last accessed on 2016 May 24].  Back to cited text no. 10
Karunatilaka DH, De Silva JR, Ranatunga PK, Gunasekara TM, Faizal MA, Malavige GN. Idiopathic purpura fulminans in dengue hemorrhagic fever. Indian J Med Sci 2007;61:471-3.  Back to cited text no. 11
[PUBMED]  Medknow Journal