SIMULTANEOUS quadrilateral gangrene is a rare finding. We are prompted to report this syndrome, since in our total experience we have never previously observed it. Review of the literature reveals a paucity of case reports. These were observed in frost bite, thromboangiitis obliterans, carcinoma, cryoglobulinemia, and endocarditis. A case of hypothermia with quadrilateral gangrene simultaneously was reported by Laufman.1 Previously Theis and co-workers2 reported another case of quadrilateral frost-bite gangrene. Luckey and his associates reported the unusual occurrence of simultaneous quadrilateral gangrene in cryoglobulinemia.3 A case of quadrilateral gangrene associated with carcinoma of the pancreas and acute nonbacterial endocarditis was reported.4 There are no references in the literature to simultaneous quadrilateral gangrene in thromboangiitis obliterans, but quadrilateral gangrene has been reported.5 Symmetrical gangrene of the lower extremities has been reported frequently. In children it has been noted by Lewis6 and Richter.7 Broders and