CASE PRESENTATION: 52 year old male with diabetes, chronic kidney disease, pulmonary emboli, and diastolic dysfunction was found down at home and brought in by EMS. On arrival, patient was intubated in severe shock with high anion gap metabolic acidosis (AG 26), hyperglycemia (1720), and acute renal failure (Cr 8.0). Physical exam was remarkable for mild abrasions on his knees and cool skin. Chest x-ray was unremarkable, pan cultures were ordered and patient started on vancomycin and zosyn. Despite four pressors, our patient decompensated with ventricular tachycardic arrest, but was revived. Bedside echo revealed EF 40-45%. Given worsening status and chest imaging with ARDS, antibiotics broadened. Dialysis was initiated for anuric kidney failure and worsening acidosis. On hospital day (HD) 3, patient developed DIC and shock liver. Large bullae appeared on bilateral lower extremities where previous abrasions were noted by HD4. Our patient continued to decompensate and patient’s family decided to focus on comfort measures only. Patient passed by HD 5 and two days later cultures revealed Clostridium subterminale.