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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.
AuthorsA E Yücel, H Kart-Köseoglu, B Demirhan, F N Ozdemir
JournalRheumatology international (Rheumatol Int) Vol. 26 Issue 5 Pg. 454-60 (Mar 2006) ISSN: 0172-8172 [Print] Germany
PMID16025335 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Anti-Inflammatory Agents
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Prednisone
Topics
  • Aged
  • Anti-Inflammatory Agents (therapeutic use)
  • Blue Toe Syndrome (diagnosis, drug therapy, pathology)
  • Coronary Angiography (adverse effects)
  • Cyclophosphamide (administration & dosage)
  • Diagnosis, Differential
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Male
  • Middle Aged
  • Prednisone (therapeutic use)
  • Vasculitis (diagnosis)

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