An autopsy case of idiopathic cholesterol embolism

Excerpt

An 80-year-old man with a clinical history of atherosclerosis was admitted showing rapidly progressive renal failure. The serum creatinine had increased from 2.2 to 7.3 mg/dl over a 2-month period. Physical examination revealed livedo reticularis associated with bluish-purple discoloration of the toes (Fig. 1a). Laboratory examinations showed eosinophilia (1120/μl) and elevated C-reactive protein (10.81 mg/dl). Skin biopsy of the toe revealed obstructive cholesterol crystals within arterioles (Fig. 1b), confirming a diagnosis of cholesterol embolism. He had no history of angiographic or vascular procedures. Although hemodialysis was initiated, his general condition did not improve, and his toes became necrotic (Fig. 1c). On the 48th hospital day he died with sepsis associated with severe bacterial pneumonia. An autopsy revealed aneurysm and numerous complexes of atherosclerotic plaques in his aorta (Fig. 2) and cholesterol clefts were also observed in multiple organs (kidneys, liver, spleen, pancreas, and adrenal glands) under microscopic examination.

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