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Clinical Images

Skin Rash and Impaired Renal Function

Kiyoshi Shikino, MD, PhD, Takahiro Ota, MD and Masatomi Ikusaka, MD, PhD

 

March 19, 2017

 

 

 

A 68-year-old man with a two-month history of unintentional weight loss was diagnosed with impaired renal function. His surgical history included total aortic arch replacement and coronary artery bypass grafting for an extensive thoracic aortic aneurysm and coronary artery disease, respectively. In addition, he had hypercholesterolemia, hypertension, and a 20-pack-year smoking history. His review of systems was negative other than weight loss. His physical examination was unremarkable other than mottled skin on his distal right hallux, characteristic of blue-toe syndrome (See Figure 1). Laboratory investigation revealed elevated creatinine (5.15 mg/dL; baseline creatinine was 0.88 mg/dL) and C-reactive protein (1.5 mg/dL), and peripheral eosinophilia (7.1%; white blood cell count: 8,100/μL). Serum complement was normal. A right hallux skin biopsy revealed cholesterol clefts (See Figure 2). 

 

MS--20502-Figure-1--RB--copy.jpg

 

MS--20502-Figure-2--RB---1--copy.jpg

 




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Authors:

Kiyoshi Shikino, MD, PhD is Project Assistant Professor of the Department of General Medicine at Chiba University Hospital in Japan.

 

Takahiro Ota, MD is a Clinical Fellow of the Department of General Medicine at Chiba University Hospital in Japan.

 

Masatomi Ikusaka, MD, PhD is a Professor of the Department of General Medicine at Chiba University Hospital in Japan.

 

 

References:

1. Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. Angiology. 1987;38(10):769-84. 

2. Hyman BT, Landas SK, Ashman RF, Schelper RL, Robinson RA. Warfarin-related purple toes syndrome and cholesterol microembolization.Am J Med. 1987;82(6):1233-7.

3. Jucgla A, Moreso F, Muniesa C, Moreno A, Vidaller A.Cholesterol embolism: still an unrecognized entity with a high mortality rate.J Am Acad Dermatol. 2006;55(5):786-93

4. Paraskevas KI, Koutsias S, Mikhailidis DP, Giannoukas AD.Cholesterol crystal embolization: a possible complication of peripheral endovascular interventions.J Endovasc Ther. 2008;15(5):614-25.  



 

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