Aims and Objective : “Reporting a case of a 63 year old female presenting with distal gangrene of all four limbs.” Background : Symmetrical peripheral gangrene is a rare clinical syndrome characterized by bilateral distal ischemic damage leading to gangrene of two or more sites in the absence of large vessel obstruction or vasculitis. SPG results in a high mortality rate ( upto 40%).About half of the patients who survives requires amputation of the affected limbs. Methods : A prospective study was done in RIMS, Ranchi, Department of General Surgery in a 63 year old female patient who presented with gangrene of all the four limbs taking into consideration the chief complains , clinical features , lab reports and colour doppler study. Result : Bilateral lower limb amputation with dysarticulation of the digits of bilateral upper limb was done and post operative phase was uneventful. Conclusion : Gangrene of all four limbs without the evidence of large vessel obstruction or vasculitis should raise the suspicion of any prevailing cardiac co–morbidity that should prompt early intervention into the cause ( like anticoagulation therapy) to prevent the progression of the disease and halt the disease process in the initial stages , thus leading to limb salvaging therapy