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).
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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.
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