A Case of Symmetrical Peripheral Gangrene: Insights Into Acute Kidney Injury Progression

Symmetrical peripheral gangrene (SPG) is a rare but life‐threatening condition characterized by ischemic necrosis in the absence of large‐vessel occlusion. SPG results from endothelial dysfunction, hypercoagulability, and impaired perfusion, often in the setting of septic shock. Despite advances in critical care, SPG carries high morbidity and mortality. We present a case of a 68‐year‐old woman with diabetes and hepatitis C cirrhosis who presented with altered mental status and a left leg wound. Forty‐eight hours after admission to the intensive care unit, she developed ischemic changes in her digits, eventually requiring multiple visits to the operating room for debridement and amputation. She developed ischemic changes in her digits in the intensive care unit following pressor use, requiring multiple visits to the operating room for debridement and amputation. The clinical course of this patient underscores the importance of early recognition and intervention in SPG; furthermore, we propose that an understanding of the thrombotic mechanism of SPG may offer insight into renal microvascular dysfunction and its role in acute kidney injury (AKI) progression. A greater understanding of SPG pathophysiology may inform novel strategies to prevent sepsis‐induced organ failure.