African Journal of Medical Case Reports

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (4), pp. 001-007, April, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Symmetrical peripheral gangrene as a Rare Complication of Malaria: A Case Report

Bekezela Siziba¹, Kwenzakwenkosi Ncube¹², Tendayi Gutu¹², Awar Majok¹, Nomathamsanqa Vundla¹, Nonsikelelo Nyathi¹

¹Department of Medicine, Mpilo Central Hospital, Bulawayo, Zimbabwe.
²National University of Science and Technology, Bulawayo, Zimbabwe.

Abstract

Received 12 March, 2026; Revised 02 April, 2026; Accepted 02 April, 2026 and Published 22 April, 2026

Severe Plasmodium falciparum malaria causes major morbidity and mortality in Sub-Saharan Africa. Symmetrical peripheral gangrene (SPG) is a rare vascular complication that leads to distal ischemic necrosis without large vessel occlusion and has seldom been reported in malaria. We describe a 30-year-old Zambian male with well-controlled HIV infection who presented with fever, confusion, hypoglycemia, hypotension and confirmed severe Plasmodium falciparum infection with 15% parasitemia. During treatment he developed acute kidney injury, jaundice, severe anemia and progressive symmetrical peripheral ischemic changes with blistering and dry gangrene of both feet, despite preserved peripheral pulses and the absence of arterial occlusion on Doppler imaging. The patient received intravenous artesunate, intravenous fluid resuscitation, hemodialysis, antibiotics, and supportive care. Although systemic recovery was achieved, the gangrene progressed requiring surgical amputation. Postoperative recovery was satisfactory with good healing of amputation stumps. This case highlights the importance of early identification of peripheral ischemic signs in severe malaria and the need for prompt multidisciplinary management to reduce morbidity and improve patient outcomes.

Keywords: Severe malaria; symmetrical peripheral gangrene; Plasmodium falciparum; microvascular ischemia; case report.
 

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (4), pp. 001-008, April, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Case Report

Perioperative Low Molecular Weight Heparin: Balancing Thromboembolism Protection and Hemorrhagic Risk

Michael K. F. Choo

Department of Anaesthesia, Box Hill Hospital, Nelson Road, Box Hill, Victoria 3128, Australia. E-mail: [email protected]. Tel.: (03) 98953333. Fax: (03) 98953461.

Accepted 16 November, 2025

A case of postoperative bleeding associated with low molecular weight heparin (LMWH) administration is reported. A literature search suggests that perioperative bleeding can be as high as 11% when LMWH is administered intraoperatively. When administered 6 h postoperatively, LMWH does not signi-ficantly increase the risk of bleeding whilst retaining efficacy for venous thromboembolism prophy-laxis. Although LMWH has not been shown to be superior when compared to unfractionated heparin for general surgery, advantages include no need for monitoring and once daily dosage. During an acute bleeding episode, bedside functional monitoring (e.g. thromboelastography) is appropriate rather than anti-Xa levels. To reverse LMWH, use protamine first to reverse its effects partially, followed by replenishing factor X and II with FFP/Prothrombinex. If bleeding continues, consider using activated factor VIIa.

Key words: Heparin, postoperative bleeding, venous thromboembolism
 

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (3), pp. 001-011, March, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Impact of Diarrhoea and Calcium Channel Blockers on Tacrolimus Toxicity: A Systematic Review

Sandrine Leroy^1,2* Sonia Fargue^3,4 Albert Bensman² Georges Deschênes⁵ Evelyne Jacqz-Aigrain⁶ and Tim Ulinski²

¹Centre for Statistics in Medicine, University of Oxford, Oxford, United-Kingdom.
²Department of Pediatric Nephrology, Armand-Trousseau Hospital, AP-HP and University Paris VI, Paris, France.
³Department of Biology, University College London, London, United-Kingdom.
⁴Department of Pediatric Nephrology - Reference Centre for Rare Renal Diseases, Femme Mère Enfant Hospital, University of Lyon, Lyon, France.
⁵Department of Pediatric Nephrology, Robert-Debré Hospital, AP-HP, Paris, France.
⁶Department of Pediatric Pharmacology - Pharmacogenetics and Clinical Investigation Center - CIC9202, Robert-Debré Hospital, AP-HP, Paris, France.

Accepted 24 November, 2025

Tacrolimus is widely used for solid-organ transplant immunosuppression. Adverse events can happen in recipients with diarrhoea or calcium channel blockers (CCBs) co-administration. We undertook a systematic review on adverse events in recipients treated with Tacrolimus for whom a raised tacrolimus trough level (≥10 ng/ml) was reported, in a situation of diarrhoea or CCB co-administration. From 312 identified studies, 16 were included, representing 65 patients. Sixty-one (94%) patients were suffering from diarrhoea, 3 (5%) received concomitant CCBs, and one (2%) presented with both; 46 (71%) were adults, 45 (69%) were kidney transplant recipients. Only 9 (14%) suffered from clinical symptoms: nephrotoxicity was reported in 9%, and required dialysis in 2%, neurotoxicity in 7%, multi-organ failure in 4%, and transient liver dysfunction in 2%. One patient was found to carry polymorphisms on CYP450 and P-glycoprotein, both involved in the tacrolimus metabolism and influenced by diarrhoea and CCB administration. Although, the risk of adverse events related to raised tacrolimus through blood level in situations of diarrhea or CCB administration is well-known and can be severe, published data is still scarce. The determination of the exact frequency of such events and the risk factors involved, such as pharmacogenetic background, would require observational cohort studies.

Key words: Calcium channel blocker, cytochrome P450, diarrhoea, P-glycoprotein, transplantation, systematic review, tacrolimus.
 

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (3), pp. 001-004, March, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Case Report

Hernia Uteri Inguinalis: An Incidental Diagnosis of PMDS with Transverse Testicular Ectopia

Suvro Ganguly*, Rabi Sankar Biswas, Makhan Lal saha, Siddhartha Bhattacharya and Soumen Das

Department of Surgery, IPGME & R/SSKM Hospital, Kolkata, India.

Accepted 25 November, 2025

Persistent Müllerian Duct syndrome (PMDS) is a rare variety of male pseudo-hermaphroditism. It is characterized by the persistence of the uterus, fallopian tubes and upper vagina in otherwise normally virilized boys. The association of the syndrome called transverse testicular ectopia (TTE), a condition in which both testes are located in one inguinal canal is rare. Here, we report a young male patient presented with infertility, left sided inguinal hernia and right-sided undescended testis since birth, finally found to have PMDS with TTE.

Key words: Müllerian duct, testicular ectopia, undescended testis, orchidopexy.
 

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (3), pp. 001-004, March, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Elevated Plasma Endothelin-1 Levels as a Marker of Vascular Injury in Hypertension and Diabetes

Usha Singh¹, R. G. Singh², Suman Singh³ and Shailja Singh⁴

¹UGC Advanced Immunodiagnostic Training and Research Centre, Institute of Medical Sciences, Banaras Hindu University, India.
²Department of Nephrology, SS Hospital, Banaras Hindu University, India.
³Department of Immunology, Institute of Medical Sciences, Banaras Hindu University, India.
⁴DST Sponsored NFTHM, Department of Nephrology, SS Hospital, Banaras Hindu University, India.

Accepted 13 September, 2025

The aim of the present study was to determine plasma levels of endothelin-1 (ET-1) in normal healthy population, patients with diabetes mellitus (DM) and its correlation with hypertension and nephropathy in DM. A total of 34 patients with DM, that included 19 cases with simple DM without nephropathy and 15 cases with diabetic nephropathy were used in the study. Four of the cases were considered simple DM and seven cases with diabetic nephropathy were also hypertensive. Thirty three healthy controls were included in the study. Endothelin estimation was done by indirect enzyme linked immunosorbent assay (ELISA). In healthy individuals, plasma ET-1 levels ranged from 2.6 to 5.6 pg/ml with a mean level of XX±YY. The mean value of ET-1 in diabetic nephropathy as well as in non-complicated DM was significantly higher compared to controls. ET-1 was significantly elevated in DM with hypertension compared to than in control group. We conclude from this study that ET-1 is more elevated in DM associated with hypertension and nephropathy than simple DM. The significant findings of the study are that ET-1 is significantly increased in DM whether associated with nephropathy or not and also in DM with hypertension as compared to healthy controls. The increased plasma ET-1 might be a precipitating factor for DM in the predisposed individuals. We recommend plasma ET-1assessments in DM patients especially in male patients.

Key words: Endothelin, diabetes mellitus, hypertension, endothelial dysfunction.
 

African Journal of Medical Case Reports ISSN 2756-3316 Vol. 14 (2), pp. 001-003, February, 2026. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Case report

Delayed Secondary Hemorrhage from the Nasopharynx Two Weeks Post-Adenotonsillectomy

Fazil Emre Ozkurt1 and Muhammed Fatih Evcimik2*

¹Silvan State Hospital ENT Department. Diyarbakir, Turkey.
²Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul Nisa Hospital, Istanbul, Turkey.

Accepted 25 August, 2025

Postoperative hemorrhage is an unlikely complication of adenotonsillectomy and occurs within several days following the procedure. We describe a patient with postoperative hemorrhage after adenotonsillectomy in nasopharynx at the postoperative 15th and 18th day. The study reveals that bleeding after adenotonsillectomy is an unlikely complication for the surgeon and patient, and requires extra experimental instruments such as endoscopy. Hence, it is best to observe the patient until blood levels stabilize and bleeding stops.

Key words: Adenoidectomy, tonsillectomy, adenotonsillectomy, epistaxis.