Cholesterol embolism occurs in patients with atherosclerotic disease after undergoing an invasive vascular procedure or receiving an anticoagulant or thrombolytic agent within the past several months. Emboli from ruptured atheromatous plaques occlude small and medium arterioles, causing ischemia and inflammation with organ dysfunction. Clinical features include rash (livedo reticularis), AKI, purple discoloration of the toes, bowel ischemia, neurologic manifestations, and eosinophilia.