Case Presentation: We present a 71-year-old male with stage IV melanoma on cycle 17 of Nivolumab admitted after presenting with altered mental status, hypotension, tachycardia, fever of 40.5°C, hypoxia requiring BiPAP, and grade 3 maculopapular rash. Labs revealed serum creatinine of 1.68, platelet count of 86, fibrinogen of 260, PT 11.2, PTT 42, d-dimer > [...]