Systemic cholesterol embolization syndrome associated with myeloperoxidase-anti-neutrophil cytoplasmic antibody.
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.
Sugimoto
Toshiro
T
Department of Medicine, Shiga University of Medical Science, Seta, Otsu.
Morita
Yoshikata
Y
Yokomaku
Yukiyo
Y
Isshiki
Keiji
K
Kanasaki
Keizo
K
Eguchi
Yutaka
Y
Koya
Daisuke
D
Kashiwagi
Atsunori
A
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
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D009195:Peroxidase