African Journal of Medical Case Reports

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (4), pp. 001-007, April, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Symmetrical peripheral gangrene as a Rare Complication of Malaria: A Case Report

Bekezela Siziba¹, Kwenzakwenkosi Ncube¹², Tendayi Gutu¹², Awar Majok¹, Nomathamsanqa Vundla¹, Nonsikelelo Nyathi¹

¹Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
²National University of Science and Technology, Bulawayo, Zimbabwe.

Abstract

Received 12 March, 2026; Revised 02 April, 2026; Accepted 02 April, 2026 and Published 22 April, 2026

Severe Plasmodium falciparum malaria causes major morbidity and mortality in Sub-Saharan Africa. Symmetrical peripheral gangrene (SPG) is a rare vascular complication that leads to distal ischemic necrosis without large vessel occlusion and has seldom been reported in malaria. We describe a 30-year-old Zambian male with well-controlled HIV infection who presented with fever, confusion, hypoglycemia, hypotension and confirmed severe Plasmodium falciparum infection with 15% parasitemia. During treatment he developed acute kidney injury, jaundice, severe anemia and progressive symmetrical peripheral ischemic changes with blistering and dry gangrene of both feet, despite preserved peripheral pulses and the absence of arterial occlusion on Doppler imaging. The patient received intravenous artesunate, intravenous fluid resuscitation, hemodialysis, antibiotics, and supportive care. Although systemic recovery was achieved, the gangrene progressed requiring surgical amputation. Postoperative recovery was satisfactory with good healing of amputation stumps. This case highlights the importance of early identification of peripheral ischemic signs in severe malaria and the need for prompt multidisciplinary management to reduce morbidity and improve patient outcomes.

Keywords: Severe malaria; symmetrical peripheral gangrene; Plasmodium falciparum; microvascular ischemia; case report.