Gangrene is an uncommon complication in cases of rickettsial spotted fever. We report three cases of spotted fever from south India, presumably caused by Rickettsia conorii subspecies indica. Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome (MODS) like acute kidney injury, liver dysfunction, delirium and seizure. One patient died while the other two recovered well. This case series is being reported to highlight the occurrence of gangrene in spotted fever rickettsiosis and the importance of appropriate management at the earliest.