Question: A 48-year-old Caucasian woman with congenital malrotation, juvenile diabetes, and prior en bloc small bowel and pancreas transplant in 2010 was admitted to our hospital with acute onset hypotension, fever, and lethargy that occurred during hemodialysis. After the transplant, the patient’s course was complicated by chronic rejection and renal failure. She had been dependent on total parenteral nutrition and was also on renal replacement therapy. Her immunosuppression regimen consists of low-dose tacrolimus (0.5 mg by mouth twice daily) and hydrocortisone (15 mg by mouth 3 times a day).