Acute digital ischemia in a child following a suspected arthropod bite: A case report

Acute limb ischemia is exceptionally rare in pediatric patients and poses a significant risk of permanent disability or limb loss. While arthropod bites are typically benign and self-limited, this case illustrates an unusual presentation of digital ischemia in a previously healthy toddler, suspected to be associated with an arthropod exposure. This report contributes to the limited literature highlighting vascular complications secondary to insect-related injuries in children.

A 2-year and 5-month-old male presented with a 3-day history of black discoloration in the second and third toes of the right foot, accompanied by erythema and localized tenderness.

There was no history of trauma, systemic illness, or recent vascular instrumentation. The child's mother recalled observing an arthropod near the foot prior to symptom onset. Physical examination revealed ischemic changes localized to the affected toes without systemic involvement. Laboratory investigations revealed iron deficiency anemia with normal inflammatory and coagulation markers. Doppler ultrasound showed absent arterial flow in the plantar arch. A diagnosis of localized vascular compromise, potentially induced by an arthropod bite, was established based on clinical and imaging findings after exclusion of systemic causes.

The patient was treated conservatively with subcutaneous enoxaparin, low-dose aspirin, and prophylactic antibiotics. Surgical intervention was not required.

Over the course of 30 days, the patient showed complete clinical recovery with full restoration of tissue perfusion.

This case emphasizes the importance of considering arthropod bite-induced vascular injury as a rare but significant differential diagnosis in pediatric digital ischemia. Early recognition and conservative management can lead to favorable outcomes and avoid invasive interventions.