Symmetrical Peripheral Gangrene Associated with Plasmodium Vivax Malaria: A case report with a brief review of literature.

Symmetrical peripheral gangrene (SPG) is an exceptionally uncommon complication of malaria, predominantly linked with Plasmodium falciparum and mixed infections. We report a 41-year-old female who presented to a tertiary care centre of eastern India in 2022 with complaint of fever with chills and rigor for 4 days along with pain and acrocyanosis of distal portions of bilateral upper and lower limbs for last 2 days. Investigations revealed anaemia and neutrophilic leucocytosis with thrombocytopaenia. The peripheral smear revealed trophozoites of P. vivax and the malaria rapid diagnostic test confirmed the presence of P. vivax antigen. D-dimer and fibrin degradation product was elevated and prothrombin time and activated partial thromboplastin time were prolonged; arterial colour doppler of all 4 extremities were within normal limits. A diagnosis of P. vivax malaria was made complicated with disseminated intravascular coagulation leading to SPG.