Symmetrical peripheral gangrene in disseminated tuberculosis.

We report the case of a 66-year-old man who developed a symmetrical peripheral gangrene (SPG) on both feet during disseminated miliary tuberculosis. Mycobacterium tuberculosis was not only isolated from sputum, gastric juice, and urine, but also from a blood culture. Since a disseminated intravascular coagulopathy was very likely to be excluded, it is possible that the SPG was due to embolization of arterioles by the tubercle bacilli. The literature of SPG is reviewed and the different possible pathogenic mechanisms of SPG, such as hypoxemia, vasoconstriction, primary endothelial damage, and vascular obstruction, are discussed. SPG is another cutaneous manifestation of disseminated tuberculosis.