case_images: PMC7441411_01
case_images: Purpuric rash on bilateral lower extremities.
case_images: CRIM2020-1607141.001.jpg
case_images: PMC7441411_01_CRIM2020-1607141.001.jpg
case_images: fig1
case_images: His lower extremities showed bilateral nonblanching, palpable purpuric lesions, primarily involving his shins (Figure 1).
case_images: MRI of brain with contrast showing acute-to-subacute 5.3 mm embolic brain infarct (blue arrow).
case_images: CRIM2020-1607141.002.jpg
case_images: PMC7441411_01_CRIM2020-1607141.002.jpg
case_images: fig2
case_images: His brain MRI noted an 8 mm left parietal lobe acute-to-subacute infarct (Figure 2).
case_images: TEE: long-axis view of the aortic valve shows partially calcified aortic leaflet vegetation with significant aortic regurgitation per Doppler study.
case_images: CRIM2020-1607141.003.jpg
case_images: PMC7441411_01_CRIM2020-1607141.003.jpg
case_images: fig3
case_images: The subsequent transesophageal echocardiogram (TEE) showed a partially calcified aortic valve with severe aortic regurgitation and mild aortic stenosis (Figure 3).
case_images: 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).
case_images: CRIM2020-1607141.004.jpg
case_images: PMC7441411_01_CRIM2020-1607141.004.jpg
case_images: fig4
case_images: 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.