Symmetrical peripheral gangrene: A rare case with unpredictable presentation and tragic outcome

Symmetrical peripheral gangrene (SPG) is a rare condition characterized by acute ischemic damage in multiple extremities without any obstruction or vasculitis in the supplying vessels. It commonly affects the toes, hands, scrotum, and earlobes, increasing the risk of limb amputation and significantly impacting the patient’s quality of life. The underlying vascular injury mechanism is disseminated intravascular coagulation, and SPG can manifest unpredictably in conditions associated with septic shock, low output states, vasospastic conditions, myeloproliferative disorders, or hyper viscosity syndrome. In this case study, a 19-year-old woman presented with bluish-black blisters on her feet and legs, accompanied by pain. The blisters gradually increased in size and burst, resulting in a watery discharge tinged with blood. Despite various investigations and treatments involving multiple departments, the patient ultimately succumbed to septic shock and passed away on June 13, 2023, as confirmed by a house officer and a senior resident.