Cholesterol crystal embolization mimicking vasculitis: success with corticosteroid and cyclophosphamide therapy in two cases

Abstract

Cholesterol crystal embolization is a potential complication of atherosclerosis. Approximately one-third of the patients who develop this problem have a history of vascular surgery, angiography or angioplasty hours to weeks before onset. The skin and the kidneys are most frequently involved, but any organ can be affected. Livedo reticularis of the lower extremities and acrocyanosis (known as "blue toe syndrome") are the most common cutaneous manifestations. Histological examination is the only way to definitively diagnose cholesterol crystal embolization. Recently, it has been proposed that cholesterol embolization is associated with vasculitis, and some authors have labeled this condition a "vasculitis look-alike." There is still no specific treatment for this problem, even in cases that progress to renal failure. However, a few case reports in the literature have noted successful treatment with corticosteroids and cyclophosphamide in patients with deteriorating renal function. In this article, we describe two cases of severe cholesterol crystal embolization accompanied by renal dysfunction) and blue toe syndrome. Both patients benefited from corticosteroid and cyclophosphamide therapy.

Contrast-induced acute kidney injury: A review of practical points

“…Once developed, CI-AKI necessitates only supportive measures. However since CES is a type of allergic-immunological disease, anti-inflammatory treatments such as corticosteroids and cyclophosphamide may be considered[92,93]. But there is no proof of efficacy of these anti-inflammatory treatments on CES.…”

Atheroembolic renal disease

“…Possible benefi ts of steroids have been reported in small series. [88][89][90] Belenfant and co-workers 10 used low-dose steroid (0·3 mg/kg) in 18 patients with relapsing disease who had improved symptoms and nutritional intake. 10 Results of other series 72 have shown benefi cial eff ects with high doses of steroids.…”

Cholesterol embolization syndrome following thrombolysis during acute myocardial infarction

“…Most authors agree that withdrawal of anticoagulants is beneficial [5]. Corticosteroids have been also used in many cases either as monotherapy [6] or in combination with statins [5] or cyclophosphamide therapy aiming to reduce the inflammatory burden of the affected capillaries [7]. Statins are also considered as a key therapeutic measure.…”