# Purpura Fulminans With Digital Gangrene in Severe Plasmodium falciparum Malaria: A Case Presentation

## TL;DR

A 66-year-old woman with severe malaria developed purpura fulminans and digital gangrene despite early treatment.

## Contribution

This case highlights the progression to gangrene in severe P. falciparum malaria despite prompt antimalarial therapy.

## Key findings

- Purpura fulminans and gangrene occurred in a patient with cerebral malaria.
- Early treatment with artesunate and hyperbaric oxygen did not prevent gangrene.
- Systemic recovery was achieved despite limb complications.

## Abstract

Purpura fulminans and peripheral gangrene are rare and severe complications of malaria, resulting from microvascular thrombosis driven by endothelial injury, cytokine-mediated coagulation and depletion of anticoagulants. Because there are no effective strategies to prevent progression to gangrene, the most important part of the management is initiating effective antimalarial therapy as soon as possible. In this report, the authors describe the case of a 66-year-old woman who returned from Angola without antimalarial chemoprophylaxis and presented with cerebral malaria due to Plasmodium falciparum infection. Despite early intravenous artesunate, hyperbaric oxygen therapy and supportive care, she developed purpuric lesions on the feet that evolved to gangrene, although systemic recovery was achieved.