SHM Converge Scientific Abstract ePoster Gallery-Cholesterol Embolization Syndrome: Atypical Skin Findings

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This case report describes cholesterol embolization syndrome (CES), a rare complication of vascular procedures caused by cholesterol crystals embolizing to distal arteries and leading to progressive organ damage. The authors emphasize that CES is often missed because symptoms develop slowly and can be nonspecific.<br /><br />The patient was a 56-year-old man with severe diffuse atherosclerotic disease who developed painful, large plaques with central necrosis on both upper thighs after a left femoral endarterectomy with bypass. Although CES classically causes distal skin findings such as livedo reticularis, blue toe syndrome, and gangrene, this case shows that more proximal skin lesions can also occur.<br /><br />Retrospective review of the chart revealed earlier signs of CES that were not recognized initially, including rising creatinine, transient eosinophilia, leukocytosis, and progressive renal decline after the vascular procedure. Diagnosis was confirmed by skin biopsy showing cholesterol emboli. The condition was likely worsened by heparin exposure for a provoked DVT and later anticoagulation during treatment for NSTEMI, both of which can aggravate CES.<br /><br />The report highlights that CES should be suspected when renal function gradually worsens after vascular intervention, especially when accompanied by skin findings. Biopsy showing cholesterol clefts is diagnostic, but a clinical diagnosis can often be made based on the pattern of delayed symptoms after an inciting vascular event. Management includes avoiding anticoagulation when possible, starting high-dose statins, and optimizing cardiovascular risk factors.<br /><br />Overall, the case underscores the importance of a thorough skin exam and early recognition of CES to prevent serious complications.

Asset Subtitle

Lisa M. Hayes

Meta Tag

Author List Lisa M. Hayes, Sumeeta Mazzarolo

Category Clinical Vignettes

Concept Atheroembolic Renal Disease

Concept Renal Dysfunction

Concept Cutaneous Manifestation

Concept Cholesterol Cleft

Concept Vascular intervention

Distinguished Non-Finalist

Presenter Organization USF Internal Medicine

Presenting Author Lisa M. Hayes

Track Adult

Keywords

cholesterol embolization syndrome

vascular procedures

cholesterol crystals

atherosclerotic disease

skin biopsy

renal decline

eosinophilia

livedo reticularis

anticoagulation

statins

Atheroembolic Renal Disease

Renal Dysfunction

Cutaneous Manifestation

Cholesterol Cleft

Vascular intervention