A case of cholesterol embolism after superselective intra-arterial chemotherapy for oral-floor carcinoma

Abstract

Cholesterol embolism is a condition in which the atheroma in a large vessel wall collapses and cholesterol crystals leak into the bloodstream, causing periphery embolization, which may be caused by catheterization or cardiovascular surgery. In this paper, we describe a case of cholesterol embolism after superselective intra-arterial chemotherapy.The patient was an 81-year-old man with right oral-floor carcinoma (T2N1M0, stage Ⅲ) . Since the patient strongly desired to preserve organ function, he underwent a total of four superselective intra-arterial chemotherapy courses by the Seldinger method combined with radiotherapy (66Gy) . Before the fifth superselective intra-arterial chemotherapy course, right toe pain, purple-red spots, and sudden renal function decrease (serum Cr level ; 1.92mg/dl, eGFR level ; 26.9ml/min) were observed, and a histopathological diagnosis of cholesterol embolism was obtained from the tissue biopsy performed at the department of dermatology. Oral administration of steroids and prostacyclin preparations improved the right toe pain ; however, renal function did not improve. After completing steroid therapy, the patient was followed up in the outpatient clinic. After 3 months, cervical lymph node resurgence was observed, and systemic drug therapy was initiated. After 10 months, the patient died of pneumonia. Reportedly, the Seldinger method causes cerebral infarction in approximately 1％ of cases. Conversely, cholesterol embolism, although extremely rare, is a disease with a poor prognosis and high probability of transitioning to hemodialysis. It is suggested that the disease should be fully considered when selecting treatment options.