[Syndrome of cholesterol crystal embolism: clinical case].
Cholesterol crystal embolization syndrome is a multiorgan disease that frequently occurs as a complication of invasive cardiovascular procedures and of thrombolytic or anticoagulant therapy. The symptoms are due to the displacement of atheromatous material dislodged from unstable or injured, by mechanical manipulation, plaque to arteriolar vessels. The real incidence of cholesterol embolization is not known. Often the diagnosis is missed because of the time between intervention and clinical findings and because the organs involved can be many and various. The most common clinical manifestations are acute renal failure and hypereosinophilia. The prognosis is poor and the mortality high because of the progression of renal failure. In this case report we present the clinical history of a 62-year-old male patient with a history of cigarette smoking and hypertension who was submitted to emergency surgery following the acute dissection of a type A aortic aneurysm. About 2 weeks after surgical intervention the patient developed a multiorgan disorder (gastroenteric, neuromuscular and renal involvement) associated with hypereosinophilia and with increased levels of the markers of inflammation. The symptoms were transient and probably due to embolization of cholesterol crystals; no specific therapy was administered. On the other hand, no therapeutic regimen has been codified to date. The best clinical approach is prophylactic, that means identifying those patients who are at high risk for an invasive vascular procedure.
Scuola di Specializzazione in Medicina Interna II, Università degli Studi La Sapienza di Roma.
Claudia
C
Mandolini
Massimo
M
Trappolini
Andrea
A
Celestini
Maria Clotilde
MC
Borgia
D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D017700:Embolism, Cholesterol / Q000175:diagnosis / Q000209:etiology; D004802:Eosinophilia / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*