|Description:||This image depicts a dorsal view of a 59 year-old man’s feet who had been infected by the plague bacterium, Yersinia pestis, after having come into contact with both an infected cat, and a dead mouse in his neighborhood. The gangrenous condition of the toes had turned the dead digits black, and mummified. See PHIL 16551, 16552, and 16553 for three more images depicting this patient’s gangrenous hands and fingers.|
Two days after the exposure the patient developed fever and myalgias, and by the following day he had developed a left axillary bubo. Seven days after the initial exposure he became critically ill and was admitted to the hospital with multiple organ failure. Initial blood cultures were positive for double-curved, Gram-negative Y. pestis rods.
The patient was treated with gentamicin and survived, but necrosis of the hands and feet developed during hospitalization. He subsequently required amputation of the hands and feet.
Distal necrosis is a rare complication of severe plague and was likely the basis for the designation the "black death". The lesions, which are thought to be caused by Y. pestis endotoxin, typically begin as purpura that later become necrotic. Biopsy of the lesions has shown cutaneous hemorrhage, necrosis, and vasculitis.