Renal biopsy findings and retinal fundus photograph from patients following IV abuse of extended-release oxymorphone tablets. (A) TMA involving the arteriole with fibrinoid necrosis, extending into the vascular pole of the glomerulus (Jones silver stain, original magnification ×200). (B) Large artery showing endothelial swelling and partial lumen occlusion, with congested glomerulus below (Jones silver stain, original magnification ×100). (C) Fibrin tactoids (red asterisk) underneath swollen endothelium with overlying podocyte foot process effacement, without immune complex deposition (transmission electron microscopy, original magnification ×7100). (D) Swollen endothelium nearly occluding capillary lumen, with RBC fragments (dark black material) and overlying podocyte foot process effacement, without immune complexes. Clear vacuolated areas (black arrow) are found in endothelium and other cells, possibly representing particulate matter from adulterated tablets (transmission electron microscopy, original magnification ×2800). (E) Retinal fundus photograph in a patient experiencing loss of vision following IV abuse of extended-release oxymorphone, demonstrating numerous cotton-wool spots and microhemorrhages.