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LETTER TO EDITOR
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 37-38

Acral gangrene following diarrheal disease


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication24-Jan-2018

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P. O. Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_45_17

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How to cite this article:
Al-Mendalawi MD. Acral gangrene following diarrheal disease. Muller J Med Sci Res 2018;9:37-8

How to cite this URL:
Al-Mendalawi MD. Acral gangrene following diarrheal disease. Muller J Med Sci Res [serial online] 2018 [cited 2022 Aug 9];9:37-8. Available from: https://www.mjmsr.net/text.asp?2018/9/1/37/223914

Dear Editor,

I read with interest the case report by Aliyu on acral gangrene (AG) following diarrheal disease in a 1-year-old Nigerian boy.[1] The author postulated the development of AG in the studied patient and obviously mentioned that “it is possible that the gangrene in the index case may be related to anaerobic infection but the negative culture made it unlikely, prior use of antibiotics before presenting to the hospital might have influenced the culture result.”[1] I presume that the following four points might plausibly explain the occurrence of AG in the studied patient.

First, it was possible that the studied patient developed hypernatremic dehydration (HD) as the consequence of diarrhea. This resulted in hypoperfusion and sluggish blood movement due to hyperviscosity, which coexist in HD, resulting in the disturbed microcirculation and ending in AG.[2]

Second, to my knowledge, malaria is one of the important infections in sub-Saharan Africa, including Nigeria in terms of the substantial morbidity and mortality. It was possible that AG in the studied patient was caused by a pro-thrombotic life-threatening disease, such as disseminated intravascular coagulopathy secondary to hidden malarial infection.[3] Hence, scrutinizing for the occult malarial infection in the studied patient was solicited.

Third, to my knowledge, pediatric human immunodeficiency virus (HIV) infection is one of the important infections in sub-Saharan Africa, including Nigeria in terms of the significant morbidity and mortality they cause. It was possible that the occult HIV infection in the studied patient resulted in some form of vasculopathy culminating in thrombosis and AG.[4] Hence, CD4 count and viral overload estimations in the studied patient were envisaged.

Fourth, fulminant gangrene of the extremities following a febrile diarrheal illness like the case in question has been attributed to an undefined autoimmune mechanism.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Aliyu I. Acral gangrene following diarrhea disease. Muller J Med Sci Res 2017;8:105-6.  Back to cited text no. 1
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2.
Singh DK, Rai R. Hypernatremic dehydration leading to peripheral gangrene. Indian Pediatr 2008;45:513-4.  Back to cited text no. 2
    
3.
Ghafoor SZ, MacRae EA, Harding KG, Patel GK. Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria-induced disseminated intravascular coagulopathy. Int Wound J 2010;7:418-22.  Back to cited text no. 3
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4.
Olubaniyi AO, Short CE, Remedios D, Kapembwa M. An unexpected cause of digital gangrene: HIV associated peripheral arterial thrombosis. Br J Gen Pract 2013;63:162-3.  Back to cited text no. 4
[PUBMED]    
5.
Adogu AA, Abengove CU. Idiopathic peripheral gangrene in Nigeria. J Natl Med Assoc 1993;85:560-2.  Back to cited text no. 5
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