CASE PRESENTATION: 40 year old female with hepatitis C, polysubstance use admitted with malaise, nausea, vomiting for 3 days. On examination, she was restless, febrile (38.2°C), hypotensive (80/60) with tachycardia and tachyapnea. Laboratory analysis revealed leukocytosis (12,000/μL), thrombocytopenia (24000/μL), lactic acidosis (7mmol/L), elevated BUN (48mg/dL), creatinine (2mg/dL) and CK (15984U/L). Coagulation was abnormal (PT 23;PTT 48;INR 2.1). Procalcitonin was markedly elevated (14ng/mL). Pan-culture was obtained and empiric antibiotics (Vancomycin, Azetronam, Clindmycin) were initiated. She remained hypotensive despite fluid resuscitation requiring vasopressor support. Two days later diffuse erythematous macular and petechial skin rash developed over her lower extremities. Meanwhile she got intubated. Her skin lesions progressed rapidly with hemorrhagic bullae formation. She received FFP, platelet transfusions and underwent excisional biopsy of skin lesion. Tissue sample grew MSSA. Pathology showed septal panniculitis with small vessel leukocytoclastic vasculitis. She received intravenous immunoglobulin (IVIG) for 2 days following which skin lesions remained stable. Over the course she improved clinically and was extubated. She did undergo multiple extensive debridement of skin and soft tissue followed by Achilles tendon reconstruction but did not require amputation. She was discharged after 47 days of hospital stay.