Figure 1A: Symmetric peripheral Gangrene. Cyanosis is seen over the palms along with gangrenous fingers.
Figure 1B: Symmetric peripheral Gangrene. Cyanosis is seen over the foot along with gangrenous toes.
A 60 year old female was referred for evaluation of blackish fingers and toes since 2 days. Her heart rate (130 beats/minute), blood pressure (70/40 mmHg), respiratory rate (28 cycles/minute) and raised total cell counts revealed that she was in septic shock. Cutaneous examination revealed symmetrical cyanosis of the palms and soles with blackish fingers and toes (Figure 1a and Figure 1b). Pulsations of radial and dorsalis pedis arteries were felt. She was started on linezolid along with fresh frozen plasma. Symmetrical peripheral gangrene is symmetrical ischaemic damage in two or more distal sites with the absence of major occlusive disease. Though the general condition and cyanosis of the palms and soles improved over the next 2 days, the gangrenous part persisted with a line of demarcation between the two.