Gangrene (tissue death) on the finger of a 59 year old female patient. This case was triggered by ischemia, a rare symptom of systemic lupus erythematosus (SLE). Ischemia is a condition caused by blocked blood vessels preventing blood and oxygen from reaching parts of the body. It can causes the fingers to become painfully cold, numb, and pale or blue in colour. Limb ischemia requires immediate treatment to restore proper blood flow. This includes medications to reduce blood pressure, endovascular treatments to open blocked arteries or surgery to repair an artery. If not treated quickly, the lack of blood flow can lead to gangrene (tissue death). For an image of the fingers affected by ischemia taken 3 before later see images C058/5378, C058/5379 C058/5380.