INTRODUCTION: Signet Ring Cell Carcinoma (SRCC) is a mucin producing adenocarcinoma, commonly seen in the gastrointestinal tract, also rarely in the urinary bladder, pancreas, breast and gallbladder. Tumor embolism due to slowly evolving disseminated intravascular coagulation (DIC) can manifest as digital infarction and this report highlights its presentation in a case of SRCC. CASE DESCRIPTION/METHODS: An 82-year-old African American lady presented with 2 weeks of low back pain, hematuria and purplish discoloration of toes. Physical exam was significant for multiple gangrenous digits but palpable pulses. CT Abdomen and Pelvis revealed diffuse bony metastases and moderate bilateral hydronephrosis. Labs were significant for Hemoglobin of 6.6 gm/dl and Creatinine 1.8. Bone marrow biopsy was consistent with metastatic carcinoma of SRCC. Pathologic staining was positive for AE1/AE3, CK7, CK20, and CDX2, suggestive of gastric tract origin than urinary bladder. Further investigation for the location of the primary tumor was negative. Evaluation for peripheral arterial disease, vasculitis, thrombophilia, and endocarditis for digital infarction was negative. With elevated D-Dimer, prolonged PTT and normal fibrinogen suggestive of slowly evolving DIC, digital infarction from tumor embolism was diagnosed. Ureteral stent placement for hydronephrosis was attempted but was unsuccessful due to multiple clots in the bladder, likely owing to DIC and she further deteriorated to end stage renal disease. Goals of care were discussed with the patient and she was transitioned to hospice care. DISCUSSION: Slowly evolving DIC is seen in cancer (mostly adenocarcinoma), liver disease, aneurysm, hemangioma and rarely sepsis. It’s believed that the destruction and production of coagulation factors/platelets are balanced. Diagnostic labs indicate thrombocytopenia, normal to prolonged PT/PTT, normal to low fibrinogen level and elevated D-Dimer. Heparin is the treatment of choice when bleeding is not suspected. Unfortunately, heparin was contra-indicated in our patient who had hematuria. In conclusion, this case illustrates the aggressive presentation of SRCC, which can present as digital infarction. Identifying tumor embolism and slowly evolving DIC is important as it may indicate poor prognosis. This case is unique in its presentation and cancer should be ruled out in digital infarction when other common causes are not identified.