Peripheral extremity gangrene following infant oral mutilation (Ebinyo): a case report from Northern Uganda.

Background: "Ebinyo" is a form of infant oral mutilation (IOM) practiced by some traditional healers in parts of sub-Saharan Africa, and often results in severe health complications. We present a novel case of ebinyo in a child from northern Uganda which resulted in sepsis and disseminated intravascular coagulation (DIC) with peripheral extremity gangrene. Case Presentation: A 3-year-old male presented with two weeks of epistaxis, oralbleeding, and cough to a large referral hospital in northern Uganda. At home, the child had undergone ebinyo, performed by a traditional healer, and was receiving treatment for malaria. On arrival, the child presented with fever, jaundice, and malaise. Labs revealed pancytopenia and an elevated D-dimer, diagnosed as DIC. On day four, physical exam revealed demarcated darkening of the fourth digit on the right foot and third and fourth digits on the left foot, diagnosed as dry gangrene. A doppler ultrasound revealed lower extremity arterial insufficiency. On day seven, the patient started improving with vancomycin. On day eleven, the patient was discharged. Conclusion: This case describes an uncommon sequela of sepsis and DIC with peripheral extremity gangrene after undergoing ebinyo. Prompt identification of ebinyo is critical for diagnosis and management of its complications.