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We report a 40-year-old female with polysubstance exposure, including cocaine and amphetamines, who presented with acute right lower extremity ischemia and compartment syndrome. Computed tomographic angiography demonstrated distal tibial, peroneal, and posterior tibial arterial occlusion. The patient underwent emergent four-compartment fasciotomy, allowing Doppler signals to return. Postoperative complications included rhabdomyolysis, acute kidney injury, bilateral adrenal infarctions, left renal infarction, and persistent foot drop. This case highlights the need to consider stimulant-associated vasculopathy in patients with acute limb ischemia without an embolic source and to evaluate for concurrent renal and visceral ischemic injuries. Early recognition and multidisciplinary management are essential to reduce morbidity.<\/jats:p>","DOI":"10.1093\/jscr\/rjag930","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T18:55:03Z","timestamp":1792436103000},"source":"Crossref","is-referenced-by-count":0,"title":["Diffuse stimulant-associated vasculopathy presenting with acute limb ischemia, compartment syndrome, and multifocal visceral infarction"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1301-5265","authenticated-orcid":false,"given":"Syed Azaan","family":"Adnan","sequence":"first","affiliation":[{"name":"Campbell University School of Osteopathic Medicine, Leon Levine Hall of Medical Sciences , 4350 US Hwy 421 S, Lillington, NC 27546 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne","family":"Wanner","sequence":"additional","affiliation":[{"name":"Campbell University School of Osteopathic Medicine, Leon Levine Hall of Medical Sciences , 4350 US Hwy 421 S, Lillington, NC 27546 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Moaiz","family":"Adnan","sequence":"additional","affiliation":[{"name":"Brock University, Department of Health Sciences , 1812 Sir Isaac Brock Way, St. Catharines L2S 3A1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Thompson","sequence":"additional","affiliation":[{"name":"WakeMed Health and Hospitals, Department of Addiction Medicine , 3000 New Bern Ave, Raleigh, NC 27610 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"2026101914545675200_ref1","doi-asserted-by":"publisher","first-page":"678","DOI":"10.4065\/mcp.2010.0133","article-title":"Peripheral artery disease: current insight into the disease and its diagnosis and 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