PMC8092113_01
Variation of the gangrene tissues and histopathologic examination of necrosis extremities. (A and B) Initial presentation of necrotic toes and finger without a defined boundary at admission. (C) Limb angiography of left leg, with well-collateral circulation. (D) Histopathologic examination of necrosis toes with dead blood vessel (yellow arrow), white cells rupture and remained nuclear dust (black arrows), (original magnification x400). (E and F) Toes and fingers healed entirely.
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On admission, physical examination revealed gangrenous lesions at the left second and third toes, and the surrounding skin was red without exudation (Figure 1A). The right index finger was purple; the small finger was significant swelling, pain, and dark violet (Figure 1B). Lower limb angiography demonstrated left anterior tibial artery and peroneal artery occlusions but with well collateral circulation (Figure 1C). After the gangrene stabilized, we removed the necrotic tissues from the wound bed, and the pathology of the necrotic toes was leukocytoclastic vasculitis (Figure 1D). Now the patient is treated with tenofovir 300 mg QD, and after 30 months follow-up, there is no symptom and recurrence (Figure 1E and F).