Symmetrical peripheral gangrene, an uncommon complication of tuberculosis.

A 74-year-old manwas admitted with abdominal discomfort, fever and chills in the previous 2 weeks. Physical examination revealed a vague Murphys’ sign on abdominal palpation. Abdominal ultrasonography demonstrated a distended gallbladder and acute cholecystitis was initially diagnosed. He underwent a laparoscopy and multiple caseous nodules over the peritoneal cavity were found. Histopathological examination revealed granulomatous inflammation with several acid-fast bacilli. The patient received anti-tuberculous chemotherapy. However, progressive symmetrical acrocyanosis with bulla formation of peripheral extremities developed on Day 4 post-laparoscopy (Figure 1). Surgical tissue and blood cultures yielded Mycobacterium tuberculosis. No other pathogen was found from blood or other culture sampling. The patient was discharged with anti-tuberculous medication without the need for amputation or graft surgery. Symmetrical peripheral gangrene (SPG) is a symmetrical distal acrocyanosis of two or more extremities that progresses to gangrene in