第2巻 2006年4月　第2号

■症例から学ぶ

コレステロール結晶塞栓症（CCE）―ステロイド療法とLDLアフェレーシス併用の効果
岡崎　怜子¹, 菊池　有史¹, 平山　悦之¹, 丸山　光紀¹, 高木　元¹, 高野　仁司¹, 高山　守正¹, 小林　義典¹, 高野　照夫¹, 高田　大輔², 金子　朋広², 飯野　靖彦², 片山　泰朗², 三石　剛³, 川名　誠司³, 葉山　修陽^4
1日本医科大学内科学第一
²日本医科大学内科学第二
³日本医科大学皮膚科学
⁴日本医科大学腎クリニック

Cholesterol Crystal Embolizm (CCE): Efficacy of a Combined Therapy of LDL Apheresis and Corticosteroid for CCE
Reiko Okazaki¹, Arifumi Kikuchi¹, Yoshiyuki Hirayama¹, Mitsunori Maruyama¹, Gen Takagi¹, Hitoshi Takano¹, Morimasa Takayama¹, Yoshinori Kobayashi¹, Teruo Takano¹, Daisuke Takada², Tomohiro Kaneko², Yasuhiko Iino², Yasuo Katayama², Tsuyoshi Mitsuishi³, Seiji Kawana³ and Naoaki Hayama^4
1The First Department of Internal Medicine, Nippon Medical School
²The Second Department of Internal Medicine, Nippon Medical School
³Department of Dermatology, Nippon Medical School
⁴Renal Clinic of Nippon Medical School

Cholesterol crystal embolism (CCE) is a systemic disorder caused by microshowers of cholesterol crystals. It brings about decreased microcirculation and is manifested in various organs including the kidneys, skin, brain and extremities. Cholesterol microshowers are thought to occur in about 50% of invasive vascular procedures, but most cases are clinically silent. CCE has a high mortality rate, but there are as yet no established methods for managing it.
We report two cases (63-year-old and 73-year-old males) of progressive renal insufficiency with eosinophilia and peripheral ischemic symptoms such as livedo reticularis and foot pain following percutaneous coronary intervention (PCI) for acute myocardial infarction. In the first case, we made a diagnosis of CCE based on clinical findings, which included deteriorating renal failure after PCI, peripheral eosinophilia, livedo reticularis, smoking history, uncontrollable hypertension, and severe atherosclerotic plaque of the aorta demonstrated by transesophageal echocardiography. In the second case, skin biopsy specimens confirmed a diagnosis of CCE.
In both cases, treatment with prostaglandins and statins was unsatisfactory. However, additional treatment with LDL apheresis (LDL-A) and corticosteroids improved the eosinophillia, livedo reticularis, foot pain and renal function, suggesting that this combined treatment may have a beneficial effect on CCE.

日医大医会誌 2006; 2(2), 115-120

Key words
Cholesterol Crystal Embolizm (CCE), corticosteroid, LDL apheresis

Correspondence to
Reiko Okazaki, First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：Okazaki_Reiko/med1@nms.ac.jp

受付：2006年2月1日　受理：2006年3月13日