Systemic Cholesterol Embolization Syndrome Associated with Myeloperoxidase-anti-neutrophil Cytoplasmic Antibody

Sugimoto, Toshiro; Morita, Yoshikata; Yokomaku, Yukiyo; Isshiki, Keiji; Kanasaki, Keizo; Eguchi, Yawara; Koya, Daisuke; Kashiwagi, Atsunori

doi:10.2169/internalmedicine.45.1553

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…1 To our knowledge, however, this is the first report of systemic CES causally related to anticardiolipin antibody. The existence of anti-phospholipid antibody may be a risk factor for CES after an invasive vascular procedure and requires well informed consents from the patients.…”

Section: Discussionmentioning

confidence: 75%

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Systemic cholesterol embolization syndrome in a patient positive for anti-cardiolipin antibody

Nakamura

Tokura

2010

Dermato-Endocrinology

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Cholesterol embolization syndrome (CES) is a systemic disorder due to a cholesterol crystal embolization from atherosclerotic plaques on the walls of arteries.1 Although CES can take place spontaneously, it often occurs after an invasive vascular procedure. CES exhibits several cutaneous manifestations, such as livedo reticularis, cyanosis, gangrene and cutaneous ulcers, prior to systemic manifestations including renal failure, abdominal pain and acute pulmonary edema. 2 We present a case of CES with anti-cardiolipin antibody who exhibited livedo reticularis, a cyanotic toe and acute pulmonary edema. Case ReportA 76-year-old man presented with an acute pain in his left fifth toe. One month before his visit, he had undergone a heart catheterization for evaluation and treatment of his acute myocardial infarction. Physical examination revealed livedo reticularis on the left foot (Fig. 1A) and cyanotic left fifth toe with purpura (Fig. 1B). The biopsy specimen from the left fifth toe revealed that a small artery in a deep dermis contained biconvex, needle-shaped clefts, hyperplastic intimal proliferation and slight inflammatory infiltrates and erythrocytes within a vessel (Fig. 1C). Laboratory examination demonstrated elevated C-reactive protein (4.65 mg dL -1 ; normal, 0-0.2), slightly elevated serum creatinine (1.28 mg dL -1 ; normal, 0.6-1.1), slightly elevated blood urea nitrogen (25 mg dL -1 ; normal, 8-22) and normal leukocyte count (7,800 μL -1 ; normal, 3,100-9,100) and platelet count (260,000 μL -1 ; normal, 157,000-340,000). Further examination disclosed that anti-cardiolipin antibody was present, while anti-β2-glycoprotein-1 antibody was not detected. Anti-nuclear antibody was within normal limit. One week after the first visit to our hospital, the patient noticed an abrupt chest pain and radiographic examinations revealed an Cholesterol embolization syndrome (CES) is caused by a cholesterol crystal embolization from atherosclerotic plaques on the walls of arteries. it often occurs after an invasive vascular procedure. CES exhibits several cutaneous manifestations before systemic symptoms take place. here, we report a case of CES, positive for an anti-cardiolipin antibody, with a history of cerebral infarction. the existence of anti-phospholipid antibody may be a risk factor for CES after an invasive vascular procedure.Systemic cholesterol embolization syndrome in a patient positive for anti-cardiolipin antibody motonobu nakamura* and Yoshiki tokura Department of Dermatology; university of occupational and Environmental health; Fukuoka, Japan Key words: systemic cholesterol embolization syndrome, anti-phospholipid antibody syndrome, anti-cardiolipin antibody acute pulmonary edema. After the systemic administration of corticosteroid, both the pulmonary edema and livedo reticularis on the foot subsided gradually. Based on the clinical and laboratory findings, we diagnosed him as having CES associated with anti-cardiolipin antibody. DiscussionAnti-phospholipid antibodies, including anti-cardiolipin antibodie...

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Section: Discussionmentioning

confidence: 75%

“…1 Although CES can take place spontaneously, it often occurs after an invasive vascular procedure. CES exhibits several cutaneous manifestations, such as livedo reticularis, cyanosis, gangrene and cutaneous ulcers, prior to systemic manifestations including renal failure, abdominal pain and acute pulmonary edema.…”

mentioning

confidence: 99%

Systemic cholesterol embolization syndrome in a patient positive for anti-cardiolipin antibody

Nakamura

Tokura

2010

Dermato-Endocrinology

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“…Cholesterol embolism associated with ANCA has rarely been reported. To date, only 11 cases reported in English could be retrieved from the PubMed database ( ) using the term ‘cholesterol embolism plus ANCA’ ( 9 – 18 ). Clinical characteristics and laboratory findings of these 12 patients (including the present case) are listed in Table I .…”

Section: Discussionmentioning

confidence: 99%

Anti-neutrophil cytoplasmic antibodies in cholesterol embolism: A case report and literature review

Zhang

Chen

et al. 2016

Experimental and Therapeutic Medicine

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Cholesterol embolism is a multisystemic disorder with clinical manifestations that resemble vasculitis. Anti-neutrophil cytoplasmic antibodies (ANCA) are a defining feature of ANCA-associated vasculitis, and the presence of ANCA in cholesterol embolism complicates its differential diagnosis and treatment. At present, the role of ANCA in cholesterol embolism remains unclear and no effective treatment is currently available. The present study reports the case of an Asian male who presented with spontaneous cholesterol embolism with proteinase 3 (PR3)-specific ANCA, subacute interstitial nephritis and late-developing skin lesions. The 69-year-old patient was admitted to The First Affiliated Hospital of Xiamen University (Xiamen, China) complaining of chest tightness, fatigue, progressive renal failure and refractory hypertension. In addition, transient eosinophilia was detected. Following immunosuppressive therapy with steroids and cyclophosphamide for 6 months, hemodialysis treatment was initiated. Skin lesions appeared at >1 month following hemodialysis initiation; however, they were gradually improved following treatment with atorvastatin and anti-platelet aggregation therapy for 5 months. The patient was maintained on hemodialysis for ~2 years and exhibited general good health at the most recent follow-up. In addition, 11 cases of cholesterol embolism associated with ANCA reported in the literature were discussed in the present study.

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“…14 A vasculitislike picture has also been reported, although it is uncertain whether this is a cause or effect phenomenon. 15 The pathophysiology of cholesterol atheroembolism has been well described and could be explained via 2 mechanisms. The first mechanism involves cholesterol embolism with direct occlusion of the arterioles causing tissue ischemia and damage.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Atheroembolism of the Colon can Mimic the Endoscopic Features of Pseudomembranous Colitis

Lim

Roslani²,

Pang³

et al. 2008

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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The endoscopic features of cholesterol atheroembolism affecting the colon have not been extensively described in the literature, owing to the rarity of this entity. We report a middle-aged man who presented with hematochezia after recent coronary artery bypass graft surgery. Colonoscopy revealed ulcerative skip lesions with overlying slough resembling pseudomembranes distal to the transverse colon, inconsistent with the initial clinical impression of ischemic colitis. As a consequence of continued bleeding with hemodynamic instability, the patient underwent an extended low anterior resection with end transverse colostomy. Histology revealed cholesterol atheroembolism resulting in patchy ischemic ulceration of the colon. Colonic cholesterol atheroembolism can mimic the endoscopic features of pseudomembranous colitis.

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Systemic Cholesterol Embolization Syndrome Associated with Myeloperoxidase-anti-neutrophil Cytoplasmic Antibody

Abstract: A 75-year-old

Cited by 12 publications

References 27 publications

Systemic cholesterol embolization syndrome in a patient positive for anti-cardiolipin antibody

Systemic cholesterol embolization syndrome in a patient positive for anti-cardiolipin antibody

Anti-neutrophil cytoplasmic antibodies in cholesterol embolism: A case report and literature review

Cholesterol Atheroembolism of the Colon can Mimic the Endoscopic Features of Pseudomembranous Colitis

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