The symmetrical peripheral gangrene syndrome is characterized by ischemic distal lesions in two or more extremities, without the obstruction of large vessels. The ischemia affecting extremities takes place when the arterial blood flow is insufficient to satisfy the metabolic demands of muscles in rest. We present a 22-year-old patient treated with norepinephrine after a septic shock suspicion who presented distal ischemia of fingers, toes, and scalp. There is no consensus about the initial treatment. Improved data gathering is necessary for a better understanding of the mechanisms involved, which could improve treatment and prevent amputation as the final therapeutic option.
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