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Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report

Cholesterol embolization syndrome (CES) is a rare but systemic severe disease caused by the distal showering of cholesterol crystals after angiography, major surgery, thrombolysis, or anticoagulation. Here, we present a case of a 74-year-old male with a history of coronary artery disease, chronic ki...

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Autores principales: Akpala, Christeebella, Kim, Grace, Froehling, David, Comfere, Nneka, Sominidi Damodaran, Sindhuja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10640895/
https://www.ncbi.nlm.nih.gov/pubmed/38022197
http://dx.doi.org/10.7759/cureus.46986
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author Akpala, Christeebella
Kim, Grace
Froehling, David
Comfere, Nneka
Sominidi Damodaran, Sindhuja
author_facet Akpala, Christeebella
Kim, Grace
Froehling, David
Comfere, Nneka
Sominidi Damodaran, Sindhuja
author_sort Akpala, Christeebella
collection PubMed
description Cholesterol embolization syndrome (CES) is a rare but systemic severe disease caused by the distal showering of cholesterol crystals after angiography, major surgery, thrombolysis, or anticoagulation. Here, we present a case of a 74-year-old male with a history of coronary artery disease, chronic kidney disease, peripheral vascular disease, antiphospholipid syndrome, and right internal carotid artery occlusion who developed purple discoloration and ulceration involving several toes two months after coronary artery bypass surgery. A broad differential diagnosis for blue toes was considered, and a biopsy was obtained, which revealed an arterial lumen filled with large cholesterol crystal spaces, confirming the diagnosis of CES. Treatment of CES remains a bimodal approach of supportive and prophylactic care. Although there is no direct evidence in favor of antiplatelet agents, their use seems reasonable because they have been shown to reduce the risk of other cardiovascular events in patients with extensive atherosclerosis. In this case, the patient's toe pain improved with the use of topical amitriptyline ketamine and has achieved complete resolution of pain and skin discoloration at a seven-month follow-up.
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spelling pubmed-106408952023-10-13 Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report Akpala, Christeebella Kim, Grace Froehling, David Comfere, Nneka Sominidi Damodaran, Sindhuja Cureus Pathology Cholesterol embolization syndrome (CES) is a rare but systemic severe disease caused by the distal showering of cholesterol crystals after angiography, major surgery, thrombolysis, or anticoagulation. Here, we present a case of a 74-year-old male with a history of coronary artery disease, chronic kidney disease, peripheral vascular disease, antiphospholipid syndrome, and right internal carotid artery occlusion who developed purple discoloration and ulceration involving several toes two months after coronary artery bypass surgery. A broad differential diagnosis for blue toes was considered, and a biopsy was obtained, which revealed an arterial lumen filled with large cholesterol crystal spaces, confirming the diagnosis of CES. Treatment of CES remains a bimodal approach of supportive and prophylactic care. Although there is no direct evidence in favor of antiplatelet agents, their use seems reasonable because they have been shown to reduce the risk of other cardiovascular events in patients with extensive atherosclerosis. In this case, the patient's toe pain improved with the use of topical amitriptyline ketamine and has achieved complete resolution of pain and skin discoloration at a seven-month follow-up. Cureus 2023-10-13 /pmc/articles/PMC10640895/ /pubmed/38022197 http://dx.doi.org/10.7759/cureus.46986 Text en Copyright © 2023, Akpala et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pathology
Akpala, Christeebella
Kim, Grace
Froehling, David
Comfere, Nneka
Sominidi Damodaran, Sindhuja
Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title_full Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title_fullStr Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title_full_unstemmed Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title_short Cholesterol Embolization Syndrome Post Invasive Arterial Procedure: A Case Report
title_sort cholesterol embolization syndrome post invasive arterial procedure: a case report
topic Pathology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10640895/
https://www.ncbi.nlm.nih.gov/pubmed/38022197
http://dx.doi.org/10.7759/cureus.46986
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