Symmetrical peripheral gangrene (SPG) is a disfiguring vascular disorder described as symmetrical distal ischemic damage leading to gangrene of two or more sites in the absence of large vessel obstruction or vasculitis. Although it tends to occur in all age groups, the youngest recorded age to our knowledge is 3.5 months. The etiologies are many and have been grouped into infectious and non-infectious causes. Bacteria and viruses such as Staphyloccocus aureus
and HIV and low flow states, as seen in hypovolemic shock for example, have been implicated.
The case we describe is a 4-week-old, HIV-exposed, small for age (SGA)preterm female who presented with passage of mucoid stool, non-projectile vomiting and continuous fever. At presentation, she was in respiratory distress and was febrile, and appeared pale with features of moderate dehydration. She had hepatomegaly and hypoactive bowel sounds. Blood culture yielded moderate growth of Staphylococcus aureus. Appropriate antibiotics were commenced. Within 20 hours of admission, she developed dry gangrene which started as bluish discoloration of the right hand progressing to the lower third of the forearm, and within a few hours her left hand and subsequently both feet were involved. Her clinical condition further deteriorated at which point she was noticed to have progressive hypoxia and a small volume pulse despite all interventions. She died before planned amputation.
This case report underscores the possibility of SPG in neonates despite its rarity and the need for clinicians to have high index of suspicion.