Digital gangrene an unusual feature of tuberculosis: A case report of a toddler from a low health resource country

Abstract

We describe a case of digital gangrene in a toddler with background disseminated tuberculosis based on non response to antibiotic treatment for twenty four days, lack of BCG immunization, positive contact with adult having chronic cough, favorable epidemiologic and radiologic features of tuberculosis. She presented with fever, cough, vomiting, weight loss and black discolouration of the fingers and toes. Patient was febrile (Temp 39.4°C), pale, had digital gangrene, peripheral lymphadenopathy and weighed 75% of her expected body weight. She was dyspnoeic, tachypnoec, respiratory rate of 42 cycles per minute with crackles. Her pulse rate was 140 beat/minute (tachycardia), in addition to hepatosplenomegaly. Chest X-ray showed features of consolidation, full blood count revealed packed cell volume of 21%, eosinophilia of 8% and erythrocyte sedimentation rate (ESR) of 130 mm/Hr. Patient remarkably improved with anti-tuberculosis drugs and discharged on follow-ups.

Keywords

Digital gangrene - disseminated tuberculosis - toddler - low health resource country