PMC7441411_01
Purpuric rash on bilateral lower extremities.
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His lower extremities showed bilateral nonblanching, palpable purpuric lesions, primarily involving his shins (Figure 1).
MRI of brain with contrast showing acute-to-subacute 5.3 mm embolic brain infarct (blue arrow).
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His brain MRI noted an 8 mm left parietal lobe acute-to-subacute infarct (Figure 2).
TEE: long-axis view of the aortic valve shows partially calcified aortic leaflet vegetation with significant aortic regurgitation per Doppler study.
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The subsequent transesophageal echocardiogram (TEE) showed a partially calcified aortic valve with severe aortic regurgitation and mild aortic stenosis (Figure 3).
Light microscopy featuring an exemplary glomerulus with collapsed capillaries (star) and extensive cellular crescents (blue arrows). Stain performed with periodic acid methamine silver (PAMS) (original magnification 20x).
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The renal biopsy showed 22 glomeruli per tissue section, four of these showing segmental fibrinoid necrosis, segmental karyorrhectic debris, and cellular crescents.  Figure 4 features light microscopy of an exemplary glomerulus featuring cellular crescents.