A 49-year-old male with PMH of hypertension and diabetes was admitted to the neurology ICU following thrombolytic therapy for left MCA occlusive thrombus. Dermatology was consulted for desquamation of the lower lip, lateral tongue, and bruising of the eyelid and cheeks. Patient originally presented to outside hospital with bilateral lower extremity swelling and shortness of breath. BNP and troponins were elevated, and ACS protocol was initiated. He had stroke-like symptoms while at the outside facility and CT showed MCA occlusive thrombus. He was transferred to our facility due to concern for stroke symptoms, where he had prompt thrombectomy with IR as well as right and left internal carotid artery intra-arterial TPA. After the procedure, bruising of the eyelids was noted. This was thought to be secondary to trauma from taping eyelids shut during the procedure. The next day, tongue swelling as well as lip swelling and desquamation were noted, so dermatology was consulted. On examination, bilateral periorbital hemorrhage was noted as well as hemorrhagic stomatitis and macroglossia. Differential at this time included systemic amyloidosis due to concern for the classic pinch purpura and skin fragility seen in systemic amyloidosis as well as macroglossia. Tongue and lip biopsies were performed. Echo was completed to work up heart failure and findings were suggestive of amyloidosis. Biopsy of the tongue and lip had amorphous pink, cracked material suggestive of amyloidosis. Congo Red stain was performed on lip biopsy and was markedly positive for amyloid deposits. Free light chains were markedly elevated.