Peripheral vascular disease are structural and functional abnormalities of the peripheral blood vessels that produce blood flow irregularities. The signs and symptoms relate either to ischemia or inflammation of the involved vessels, or to both. A previously healthy 4.5-year-old girl was referred to our hospital with bruises on fingers and toes. She had no history of environmental causes, including drug intake. Symptoms of abdominal pain, fever, and a swollen face preceded the symptoms of her extremities. On physical examination, her blood pressure, which could be obtained only on the things, was high. There were no pulses on the upper extremities or on either the a. dorsalis pedis or the a. tibialis anterior dextra. There was massive necrosis on fingers which led to dry gangrene. A rise in acute phase reactants accompanied the physical findings, and a segmental obstruction was found proximally to a. brachiales, and distally to a. radialis dextra and a. dorsalis pedis dextra on digital subtraction angiography (DSA). High-dose methylprednisolone, cyclophosphamide, salicylates and dipyridamole were given; as these medications did not relieve the symptoms, a thoracal sympathatectomy was performed. The peripheral circulation improved, but a demarcation zone developed on the fingertips, leading to amputation.