Symmetrical Peripheral Gangrene resulting from application of henna: a rare clinical occurrence

Abstract

Symmetrical Peripheral Gangrene (SPG) is a rare clinical syndrome characterized by bilateral symmetric distal limb ischemia leading to gangrene with no evidence of major vascular occlusive disease. The peripheral pulses are usually palpable as a result of the sparing of larger vessels. The mechanism of vascular occlusion is poorly understood. Disseminated intravascular coagulation has been implicated as the final common pathway in its pathogenesis. Initial management is resuscitation followed by amputation when the gangrene becomes demarcated. We report a rare case of symmetrical peripheral gangrene of both hands and feet in a 28-year-old female who presented with pain and darkening of all her fingers and toes for 2 days following the application of henna, with no medical history of the known predisposing conditions. She had amputation of the digits of her hands and tarsometatarsal amputation of her feet bilaterally. She had an uneventful postoperative period and was discharged to see the outpatient department. While reported cases of SPG due to numerous etiologies can be found in the literature, this is to our findings the first time we are seeing it resulting from the cosmetic use of henna. The intriguing case presented here was brought about by the application of henna used as a cosmetic agent and was characterized by a very rapid clinical course with no other apparent predisposing etiology.