T Enzler1, M Glatzel, M Maggiorini. 1. Departement für Innere Medizin, Universitätsspital Zürich. thomas_enzler@bluewin.ch
Abstract
HISTORY AND CLINICAL FINDINGS: A 76-year-old man was admitted for a coronary angiography because of a postinfarction angina. Clinical examination was normal except a grade 2/6 systolic murmur and a slightly impaired vibration sense. INVESTIGATIONS: A slight anaemia, a slightly impaired renal function, and a slightly elevated cholesterol level could be found. The ECG showed a chronic anterior myocardial infarction. In the coronary angiography a double vessel disease was seen. TREATMENT AND COURSE: A percutaneous transluminal coronary angioplasty of the left anterior descending artery was performed and four stents were implanted. During the procedure a rush occurred in both legs following an appearance of livedo reticularis. Renal function deteriorated and there was an markedly increased number of eosinophils. With a new neurological check a marked peripheral neuropathy could be found. A biopsy of the sural nerve showed a necrotizing granulomatous inflammation of the nerve and the surrounding small arteries. Several small arteries contained needle shaped crystal clefts in their walls. The appearances were of multiple cholesterol emboli. Besides treatment of pain an immunosuppressive therapy with prednisone (100 mg/d) and cyclophosphamide (50 mg/d) showed no improvement. The patient died 2 months after the diagnosis of cholesterol emboli. CONCLUSION: Typically, cholesterol embolism occurs in elderly men within the eight weeks after arterial procedure. Diagnosis can be made only by histological examination. Cholesterol emboli syndrome may mimic systemic vasculitis. Therapy trial of cholesterol emboli syndrome usually fails and mortality rate is high.
HISTORY AND CLINICAL FINDINGS: A 76-year-old man was admitted for a coronary angiography because of a postinfarction angina. Clinical examination was normal except a grade 2/6 systolic murmur and a slightly impaired vibration sense. INVESTIGATIONS: A slight anaemia, a slightly impaired renal function, and a slightly elevated cholesterol level could be found. The ECG showed a chronic anterior myocardial infarction. In the coronary angiography a double vessel disease was seen. TREATMENT AND COURSE: A percutaneous transluminal coronary angioplasty of the left anterior descending artery was performed and four stents were implanted. During the procedure a rush occurred in both legs following an appearance of livedo reticularis. Renal function deteriorated and there was an markedly increased number of eosinophils. With a new neurological check a marked peripheral neuropathy could be found. A biopsy of the sural nerve showed a necrotizing granulomatous inflammation of the nerve and the surrounding small arteries. Several small arteries contained needle shaped crystal clefts in their walls. The appearances were of multiple cholesterol emboli. Besides treatment of pain an immunosuppressive therapy with prednisone (100 mg/d) and cyclophosphamide (50 mg/d) showed no improvement. The patient died 2 months after the diagnosis of cholesterol emboli. CONCLUSION: Typically, cholesterol embolism occurs in elderly men within the eight weeks after arterial procedure. Diagnosis can be made only by histological examination. Cholesterol emboli syndrome may mimic systemic vasculitis. Therapy trial of cholesterol emboli syndrome usually fails and mortality rate is high.
Authors: Matthias Klein; B Hartmann; H J Groene; T A Rupprecht; C Schmidt; T Pfefferkorn; A Straube Journal: Neurocrit Care Date: 2009-09-23 Impact factor: 3.210