A rapidly progressive case of generalized atherosclerosis

We report the case of a 78-year-old patient with atherosclerosis, arterial hypertension, chronic renal failure and permanent atrial fibrillation, deceased for a rupturing abdominal aortic aneurism. In the preceding 6 months, the patient had a trophic ulcer of the malleolus and a lymphocytic vasculitis of the legs presenting as cutaneous inflammation and confirmed by skin biopsy; subsequently, he had a worsening renal failure with proteinuric nephropathy and eventually a progressive neurologic involvement with cognitive impairment, depression, bradykinesia and tremors. The symptoms were ascribed to cerebral vascular suffering. A severe generalized atherosclerosis was evidenced at autopsy. The fast worsening of atherosclerosis, with kidney and brain involvement, occurred in conjunction with the inflammatory process (vasculitis) that was only partially controlled by steroid treatment. This case supports the concept of atherosclerosis as an inflammatory disease, the course of which can be worsened by renal failure, which, in turn, is known to favor inflammatory processes.