title: A patient with idiopathic cholesterol crystal embolization: effectiveness of early detection and treatment.
abstract: A 72-year-old man was admitted to our hospital because of progressive renal dysfunction persisting for 1.5 months. Physical examination showed livedo reticularis of the toes of both feet, peripheral edema, and gait disturbance due to the toe pain. The levels of blood urea nitrogen (50.0 mg/dL) and creatinine (2.81 mg/dL) were elevated, and eosinophilia (10%, 870/µL) was noted. A biopsy of the area of livedo reticularis revealed cholesterin crystals. The patient had not undergone angiography, anticoagulation therapy, or antithrombotic treatment. Idiopathic cholesterol crystal embolization was diagnosed. Transesophageal echocardiography revealed intimal thickening of the aorta and plaque. Oral steroid therapy was started because of the progressive renal dysfunction. After steroid therapy, the symptoms improved. Early diagnosis and treatment are important. Renal dysfunction is a common symptom in elderly patients. Cholesterol crystal embolization should also be considered as a cause of unexplained renal dysfunction, especially in such patients.
authors.affiliation: Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Higo
authors.forename: Akio
authors.initials: A
authors.lastname: Hirama
authors.forename: Kae
authors.initials: K
authors.lastname: Ueda
authors.forename: Akiko
authors.initials: A
authors.lastname: Mii
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneko
authors.forename: Kouichi
authors.initials: K
authors.lastname: Utsumi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iino
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Katayama
mesh_terms: D000368:Aged; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D003460:Crystallization; D042241:Early Diagnosis; D017700:Embolism, Cholesterol / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D054068:Livedo Reticularis / Q000097:blood / Q000150:complications; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D011239:Prednisolone; D003404:Creatinine