-Case Reports-

A Patient with Idiopathic Cholesterol Crystal Embolization: Effectiveness of Early Detection and Treatment

Seiichiro Higo, Akio Hirama, Kae Ueda, Akiko Mii, Tomohiro Kaneko, Kouichi Utsumi, Yasuhiko Iino and Yasuo Katayama

Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School

A 72-year-old man was admitted to our hospital because of progressive renal dysfunction persisting for 1.5 months. Physical examination showed livedo reticularis of the toes of both feet, peripheral edema, and gait disturbance due to the toe pain. The levels of blood urea nitrogen (50.0 mg/dL) and creatinine (2.81 mg/dL) were elevated, and eosinophilia (10%, 870/μL) was noted. A biopsy of the area of livedo reticularis revealed cholesterin crystals. The patient had not undergone angiography, anticoagulation therapy, or antithrombotic treatment. Idiopathic cholesterol crystal embolization was diagnosed. Transesophageal echocardiography revealed intimal thickening of the aorta and plaque. Oral steroid therapy was started because of the progressive renal dysfunction. After steroid therapy, the symptoms improved. Early diagnosis and treatment are important. Renal dysfunction is a common symptom in elderly patients. Cholesterol crystal embolization should also be considered as a cause of unexplained renal dysfunction, especially in such patients.

J Nippon Med Sch 2011; 78: 252-256

Keywords
livedo reticularis, eosinophilia, renal dysfunction

Correspondence to
Kouichi Utsumi, MD, Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
utsumi@nms.ac.jp

Received, December 29, 2010
Accepted, March 16, 2011