title: Systemic cholesterol embolization syndrome associated with myeloperoxidase-anti-neutrophil cytoplasmic antibody.
abstract: A 75-year-old man was transferred to our department because of development of severe renal impairment after coronary artery bypass grafting. Hemodialysis was initiated for postsurgical oliguria and lung congestion. On transfer, he showed systemic purpura rashes and diffuse blue mottlings on his toes with marked eosinophilia and an elevated level of C-reactive protein. Cutaneous biopsy revealed cholesterol crystal embolism and leukocytoclastic vasculitis in dermal arterioles. Myeloperoxidase-anti-neutrophil cytoplasmic antibody titer was increased. Upon oral corticosteroid therapy following intravenous pulse steroid therapy, the purpura dramatically diminished, renal function improved, and hemodialysis was discontinued. Active treatment with corticosteroids may be effective for cholesterol embolization syndrome, particularly when clinical and laboratory manifestations mimic systemic vasculitis.
authors.affiliation: Department of Medicine, Shiga University of Medical Science, Seta, Otsu.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Yoshikata
authors.initials: Y
authors.lastname: Morita
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Yokomaku
authors.forename: Keiji
authors.initials: K
authors.lastname: Isshiki
authors.forename: Keizo
authors.initials: K
authors.lastname: Kanasaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Koya
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kashiwagi
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D017700:Embolism, Cholesterol / Q000209:etiology / Q000276:immunology*; D006801:Humans; D008297:Male; D009195:Peroxidase / Q000276:immunology*; D051437:Renal Insufficiency / Q000150:complications; D017445:Skin Diseases, Vascular / Q000209:etiology / Q000473:pathology; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000150:complications / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D009195:Peroxidase