Plastin time; C3, complement component PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/12711626 3; C4, complement component 4; CA 19-9, carbohydrate antigen 19-9; c-ANCA, cytoplasmic anti-neutrophil cytoplasmic antibodies; CEA, carcinoembryonic antigen; DIC, Disseminated intravascular coagulation; ESR, erythrocyte sedimentation rate; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; Ig, immunoglobulin; INR, international normalized ratio; PSA, prostate-specific antigen; PT, prothrombin time; RPR/VDRL, rapid plasma regain/venereal disease research laboratoryrestored. Upper GI panendoscopy was conducted because of vomitus of coffee ground material, which revealed a Mallory-Weiss tear and acute gastric ulcer with a history of recent hemorrhage. An antibiotic (ceftriaxone) and a proton pump inhibitor (omeprazole) were administered. Continuous renal replacement therapy was initiated for refractory acidosis and contrast media removal. The patient responded well to aggressive, conservative management. On the fourth day after hospitalization, a bilateral bluish discoloration of the fingers was noted. A gradual painful sensation developed 5 days after an acrocyanotic lesion was found (Fig. meo.v19.25901 1). Dry gangrene and a limited range of motion of the fingers developed 9 days after the lesion was noted. PeripheralLiao et al. Journal of Medical Case Reports (2015) 9:Page 3 ofFig. 2 a Day 12 after admission: gangrenous change over the fingers on day 9 after acrocynosis noted. b Day 26 after admission: resolution of symmetrical peripheral gangrene on day 22 after acrocyanosis noted.Fig. 1 Acrocyanosis on day 9 after admissionpulses were palpable in both the upper and lower extremities. The results of laboratory tests for SPG, comprising infection, malignancy, and the autoimmune system, were unremarkable (Table 1). Transesophageal echocardiography, carotid Doppler ultrasound, and sonography of the upper extremity vessels also were unremarkable. The patient was administered two doses of oral aspirin 75mg/day and two doses of oral pentoxifylline 400mg/day for 20 days. Because of upper GI tract bleeding noted on admission, heparin was not considered. The gangrenous lesion was kept warm and was not touched, as much as possible. The patient's condition improved steadily over the next 7 days. His pain decreased, and Tert-butyl 2-(chloromethyl)pyrrolidine-1-carboxylate his range of motion improved. Gradual desquamation of his finger skin occurred, with shedding of gangrenous scabs from the tips of his fingers and complete resolution (Fig. 2a, b). The patient was discharged from PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/9544797 the hospital stay 26 days later. The patient responded well to the treatment and returned to his normal daily activities during outpatient follow-up.Discussion SPG is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of two or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather 4,4,5,5-Tetramethyl-2-(2-methylprop-1-en-1-yl)-1,3,2-dioxaborolane than thrombosis is implicated as the underlying pathophysiology [1, 4]. The gangrenous lesions initially appear in the form of acrocyanotic and dusky discolorations of the skin starting from the distal extremity within 24?8h and resemble lesions associated with erythematous cold extremity exposure. Gangrene most commonly occurs in the distal extremities, such as the fingers, toes, tips of the nose, and ear lobules, whereas the lips or genitalia may be affected in severe cases [5]. Peripheral pulses are usually palpable as a result of sparing of the large vessels. Up to 85 of patients with SPG attributed to DIC and other pro.