In their report Yoo et al describe a 72 year old woman who presented with fever and symmetrical gangrene of the fingers and toes despite intact peripheral arterial pulses.¹Klebsiella pneumoniae grew both from blood and liver biopsy aspirates. Treatment with antibiotics, prostacyclin, tissue plasminogen activator followed by warfarin and aspirin was beneficial and led to the regression of almost all the lesions. The authors state that “Although Amital et al reported that amputation could induce remission of the systemic illness, some reports have recommended that non-surgical management is preferable if there is an intact pulse in the affected limb”.

The term “catastrophic” antiphospholipid syndrome (CAPS) is used to define an accelerated form of antiphospholipid syndrome (APS) resulting in multiorgan failure. These patients have clinical evidence of multiple organ involvement, which develops within a short period of time, in addition to histopathological evidence of multiple small vessel thrombotic occlusion and high titres …