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.