Image 23. A young woman, recently from West Africa became febrile one week before admission. Incommunicado for 3 days, she was found comatose, on her back in her apartment bed, and brought to hospital. She arrived in status epilepticus and in renal failure, with 6% P. falciparum. Over the next 3 days, intubated and on dialysis, her initially normal looking toes on both feet became cool and purple/black. Her prothrombin time was normal, her peripheral pulses good. Her coma resolved by day 4, her parasitemia with quinine/doxycycline by day 4 and her renal failure in 2 weeks. She eventually lost the distal portions of the two worst toes. What was the toe problem?
