Background: Children with Cyanotic Congenital Heart Diseases are at risk of developing thrombosis and gangrene, especially when they suffer severe fluid loss or experience significant fluid restriction.

Aim: To describe a case of a 2-year-old girl with transposition of the great arteries (TGA) who developed left lower limb gangrene following an episode of diarrhoeal disease.

Case: HB presented with four-week history of progressive darkening of her left leg, which was preceded by two days history of diarrhea and vomiting. At presentation, she had moderate dehydration and central cyanosis (SpO₂-68%), with signs of dry gangrene of the distal half of the left leg. Echocardiography confirmed d-TGA with ventricular and atrial septal defects. Packed cell volume was moderately elevated (57%), but blood culture result and other hematologic parameters were essentially normal. Patient had above-knee amputation of the left leg. She had eventful post-operative stay characterized by inter current fever and delayed wound healing (>4weeks). Unfortunately, the parents signed against medical advice despite counseling.

Conclusion: Limb gangrene may complicate cyanotic congenital heart diseases such as TGA. Diarrhoeal disease, which causes dehydration and hyper viscosity, is a potential precipitant. 

Keywords: Gangrene, Transposition of Great Arteries, Diarrhoeal Disease, Dehydration, Sokoto, Nigeria.

1. Park MK. Cyanotic Congenital Heart Defects. In: Pediatric Cardiology for practitioners. 5^th Philadelphia, Mosby Inc. 2007: 219-234
2. Kotby AA, Mamdouh1 NM, Eissa DS, Ahmed NT. Risk Factors for Thrombosis in Children with Cyanotic Congenital Heart Disease J MedSciClin Res; 2016;04(10):1317-1318
3. Mokoena T, Hadley GPS. Surgical management of multiple limb gangrene following dehydration in children. Afr Med J 1991. 17;80(4):185-188.
4. Morin C, Chevalier I. Severe Hypernatremic Dehydration and Lower Limb Gangrene in an Infant Exposed to Lamotrigine, Aripiprazole, and Sertraline in Breast Milk. Breastfeed Med 2017; 12 (6):377-380
5. Bugaje MA, Umar LW, Ogirima MO, Hassan L. Gangrene of the limb complicating Salmonella typhisepticaemia in a Nigerian child. Niger J ClinPract. 2009; 12: 335
6. Onalo R, Ogala WN, Lawal YZ, Chom ND, Odogu O, Ige SO. Congenital gangrene of the extremities in a newborn. Niger J ClinPract 2011; 14: 245-248
7. Adeodu OO, Senbanjo IO. Septicaemia complicated by digital gangrene-A case report. Niger J Paediatr 2005; 37: 137- 139.
8. Animasahun BA, Amoah EP. Gangrene of the left forearm following septicaemia in a Nigerian child with tetralogy of fallot: A case report. Heart Res Open J 2016; 4(1): 6-9
9. Rose SS, Shah AA, Hoover DR, Saidi P. Cyanotic Congenital Heart Disease (CCHD) with Symptomatic Erythroc-ytosis. J Gen Intern Med 2007;22(12): 1775-1777
10. Comay SC, Karabus CD, Peripheral gangrene in hypernatraemic dehydration of infancy. Arch Dis Child 1975;50(8):616-619
11. Bass D. H, Cywes S, Bass D. H, Peripheral gangrene in children Pediatrc Surgery International 1989; 4 (6): 408-411
12. Dogara S, Agrawal SK, Jindal R, Suri D, Ahluwalia J, Singh S. Peripheral Gangrene in a Breast Fed Neonate—Is Hypernatremic Dehydration the Cause? Indian J Pedatr 2011; 78 (12): 1543-1545
13. PrchalJ T. Elevated hematocrit, risk of thrombosis, and polycythemia vera.Blood2003; 101 (11): 4229 
14. Bhatt VR. Secondary Polycythemia and the Risk of Venous Thromboembolism J Clin Med Res 2014; 6(5): 395–397.
15. Arshad A, McCarthy MJ. Management of Limb Ischaemia in the Neonate and Infant European J VascEndovascSurg 2009; 38 (1): 61-65
16. Abdelrazeq S, Alkhateeb A, Saleh H, Alhasan H, Khammash H. Intrauterine Upper Limb Ischemia: An Unusual Presentation of Fetal Thrombophilia—A Case Report and Review of the Literature  Case Rep Pediatr, 2013 Available at: https://www.hindawi.com/journals/cripe/2013/670258/cta/

Dr Sani, Usman Muhammad

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.