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Ischemic Gangrene in a Child with Dilated Cardiomyopathy

Josephat Chinawa*, Fortune Ujunwa, Grace Agu, IjeomaArodiwe, EgbunaObidike

Gangrene from left ventricular thrombus secondary to severe left ventricular dysfunction, is a very rare disease seen in children with cardiac disease.

ON is a 6-year-old male who presented with a progressively worsening difficulty in breathing, progressively worsening facial, abdominal and leg swellings. Salient findings on examination were tender hepatomegaly, tachycardia (Pulse Rate (PR)=106 bpm) hypotension Blood Pressure (BP)=80/60 mmHg and displaced apex.

Positive findings on investigation revealed ST and Q waves abnormalities and inverted T waves on ECG, Dilated Cardiomyopathy (DCM) with pericardial effusion and left ventricular ejection fraction of 21% on echocardiography. Patient was commenced on intranasal oxygen and anti-failure regimen. He improved remarkably as evidence by improvement in clinical and echocardiographic indices.

Three days later a bluish discoloration of the left hand was noted. This progressed to form dark patchy macules, cold extremities and severe pain in the fingers with absent radial pulse and grade zero power.