title: Hemorrhagic panniculitis caused by delayed microemboli from intravascular device.
abstract: OBJECTIVE
  The breakdown of previously inserted intravascular devices can lead to microemboli that can clinically mimic the symptoms of common disorders, such as senile purpura, and have subtle histologic findings. However, device failure can occur gradually and start months after placement. If not identified early, microemboli to noncutaneous sites can cause significant morbidity and mortality.
  
  
  METHODS
  A woman in her 70s presented 6 months after a complex aortic aneurysm repair with several large ecchymoses radiating from firm subcutaneous nodules on the buttocks, arms, and thighs. Skin biopsy specimens revealed extensive hemorrhage and a panniculitis with sparse, subtle, intra-arteriole, gray amorphous deposits that, on analysis by scanning electron microscopy with energy-dispersive radiography analysis and infrared spectrometry, were most consistent with a hydrophilic polymer. This type of hydrophilic polymer coats catheters and stents such as those used in aortic aneurysm repair.
  
  
  CONCLUSIONS
  This is an unusual case of microemboli from the polymer coating intra-arterial stents starting months after placement and causing a panniculitis. Prior observations show that polymers coating intravascular devices have the potential to break down gradually and long after the device's placement, but clinical consideration for delayed microembolization is underrecognized until catastrophic impairment or death.
authors.affiliation: Department of Graduate Medical Education, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Curtis Lamar
authors.initials: CL
authors.lastname: Hardy
authors.affiliation: Department of Dermatology, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Glass
authors.affiliation: Department of Pathology, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Sorrells
authors.affiliation: Department of Dermatology, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Luke C
authors.initials: LC
authors.lastname: Nicholas
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001706:Biopsy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015434:Panniculitis / Q000175:diagnosis / Q000209:etiology*; D012867:Skin / Q000098:blood supply*; D015607:Stents / Q000009:adverse effects*