Symmetrical Gangrene

Symmetrical gangrene is a condition in which gangrene occurs in all four limbs, the nose and ears at the same time. This is a rare condition and only very few cases have been recorded. A number of conditions can cause symmetrical gangrene. These areas, i.e. the limbs, the ears and the nose, represent the outposts of the cardiovascular system. When the body needs to conserve, it conserves at the expense of the outposts maintaining the circulation for the heart, the central nervous system, respiratory system and the splanchnic areas. Symmetrical gangrene may be attributed to diabetes, arteriosclerosis or thromboangiitis obliterans. It is also met with in ergot poisoning. As a result of acute infectious fevers like typhoid, typhus and malaria, it might also occur. Page has recorded a case of symmetrical gangrene due to vitamin-B deficiency. A few cases of symmetrical gangrene have been recorded in the Africans, but in the two cases described by Michael (1947) the gangrene was confined to the legs. In this country, Raynaud's disease is not likely to be an important condition. In the African series, it was noted that the disease occurred in persons who were previously in a good state of health. All of them occurred in men. The age incidence was between 20 and 35. It started with oedema of the legs followed by pain. Gangrene occurred in both legs simultaneously. No obvious cause was detected. In contrast to this series is the case I am reporting, and which occurred in a woman of about 25 years of age. Case report.?Mrs. R., Hindu, aged 25 years, was admitted on the 25th January, 1945, with the complaint of pain, oedema and discoloration of legs up to the middle including feet, and of nose and palms, said to be of one day's duration. The illness started with sudden fever and rigor about 15 days previously. This continued in the evenings of alternate days for 8 days. On the 11th day of onset, she noticed cedema of the feet and legs with severe pain. Red patches appeared subsequently on toes, fingers and, later, on the nose. The nails showed a blue tinge. The palms of ~Le hands and left ear lobule were later affected.