Science and Education Publishing American Journal of Medical Case Reports 2374-216X 3 9 2015 08 19 Symmetrical Peripheral Gangrene, a Serious Complication of Sepsis 286 287 EN Lakshmi Kant Pathak Assistant Professor of Medicine, University Of North Dakota, Fargo, ND, USA Vimala Vijayaraghavan Nataliya Ana Wilson AJMCR2015396 10.12691/ajmcr-3-9-6 2015 05 30 2015 07 31 2015 08 19 Symmetrical peripheral gangrene (SPG) is a rare but devastating complication of septicemia, with a high mortality rate. About half of the patients who survive require amputation of the affected limb. The common etiologies include both infective and non-infective etiologies. Aggravating factors include asplenia, immunosuppression, and previous cold injury to extremities, diabetes mellitus, renal failure, increased sympathetic tone and use of vasopressors. [1] SPG is defined as symmetrical distal ischemic damage at two or more sites in the absence of large vessel obstruction or vasculitis, sometimes used synonymously as purpura fulminans. Disseminated intravascular coagulation (DIC) and hemorrhagic infarction of skin with uninvolved proximal arteries are hallmark of this condition [2].