PMC9533789_01
Rash - Non specifical blanching erythematous rash on the lower extremities sparing palms and soles.
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An erythematous confluent blanching rash sparing his palms and soles was noted on his lower extremities and back (Fig. 1).
Electrocardiogram on admission which showed nonspecific ST-T wave abnormality including some ST segment elevation and T wave inversion. In concert with elevated Troponin enzymes, there was concern for Myocarditis, pericarditis, and Non-ST elevation Myocardial Infarction.
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Electrocardiogram performed serially showed normal sinus rhythm with ST segment elevation in anterolateral leads (Fig. 2).
PMC9533789_02
Kidney Biopsy: Shows flattening or vacuolization of epithelium consistent with acute tubular injury. In the background we see multifocal interstitial inflammation with mononuclear cells, neutrophils, and eosinophils. There is mononuclear cell tubulitis consistent with acute interstitial Nephritis.
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Due to AKI requiring dialysis a renal biopsy was performed showing diffuse Acute tubular necrosis(ATN) and multifocal interstitial nephritis likely due to a combination of sepsis, hypotension, and NSAIDs (Fig. 3).