A 64-year-old Asian man, with past medical history of hypertension, hypothyroidism, and hyperlipidemia, presented with 3 days history of fever associated with cough and worsening shortness of breath. Subsequent clinical course was complicated by acute lung injury leading to acute respiratory distress syndrome requiring positive pressure ventilation, septic shock requiring inotropic support, and acute kidney injury requiring continuous renal replacement therapy (CRRT). On day 3 of CRRT, the patient developed significant hypothermia (temporal temperature 27.58C), which was successfully managed. Continuous renal replacement therapy was subsequently discontinued as renal function recovered and the patient was discharged home after a prolonged hospital stay. He currently remains off dialysis and is being followed as an outpatient for chronic kidney disease. In this article, we examine various aspects of pathophysiology and management of hypothermia on CRRT and review relevant literature in this field.

Introduction Purpura fulminans (PF) is a life-threatening syndrome consisting of Disseminated Intravascular Coagulation (DIC), thrombotic occlusion of small- and medium-sized blood vessels with skin necrosis. Although there are few studies in the literature, only a minority of them discuss renal manifestations. Case Report We present a case of a 57-year-old Caucasian female with acute kidney injury (AKI) in the setting of multiorgan failure (MOF), DIC and PF. She presented with fever, exudative drainage from her port site, and skin changes concerning for bacteremia. Empiric antibiotics were started after blood, urine, and wound cultures were obtained. None of the cultures grew any organisms. Fever resolved after port removal. She exhibited thrombocytopenia, leukopenia, and neutropenia. Urinalysis showed hyaline casts and a fractional excretion of urea (FeUrea) ≤35% indicating a pre-renal state. Her hospital course was complicated by atrial fibrillation, acute hypoxic respiratory failure requiring mechanical ventilation, and hypovolemic shock requiring pressor support. Further, complicated by multiorgan failure including non-oliguric AKI and heart failure with reduced ejection fraction (HFrEF) of ≤65%. Acute skin findings included dusky, purple macules and patches involving all digits of both hands as well as gangrenous changes on the face and toes. It prompted further investigation by Hematology and Dermatology. Skin biopsy showed early leukocytoclastic vasculitis changes. Her laboratory markers were suggestive of DIC and Purpura Fulminans.