Symmetrical lower extremity gangrene in a patient with severe malaria: a case report and literature review

Symmetrical peripheral gangrene (SPG) is an uncommon clinical entity characterized by bilateral ischemic damage resulting in gangrene, typically occurring in the absence of large-vessel occlusion or vasculitis. This case report describes a 14-year-old Ethiopian girl who developed SPG of the lower limbs in the context of severe Plasmodium falciparum malaria. She initially presented with fever, vomiting, and diarrhea, and despite prompt initiation of antimalarial therapy, progressive darkening of both feet was observed. Clinical evaluation revealed stable vital signs, preserved organ function, and palpable peripheral pulses, supporting the diagnosis of severe malaria complicated by peripheral gangrene. Management was conservative, relying on continued antimalarial treatment. This case highlights the importance of early recognition and timely intervention in SPG, underscoring the need to address underlying etiologies to optimize patient outcomes.