Cholesterol Crystal Embolizm (CCE): Efficacy of a Combined Therapy of LDL Apheresis and Corticosteroid for CCE
1The First Department of Internal Medicine, Nippon Medical School
2The Second Department of Internal Medicine, Nippon Medical School
3Department of Dermatology, Nippon Medical School
4Renal Clinic of Nippon Medical School
Cholesterol crystal embolism (CCE) is a systemic disorder caused by microshowers of cholesterol crystals. It brings about decreased microcirculation and is manifested in various organs including the kidneys, skin, brain and extremities. Cholesterol microshowers are thought to occur in about 50% of invasive vascular procedures, but most cases are clinically silent. CCE has a high mortality rate, but there are as yet no established methods for managing it.
We report two cases (63-year-old and 73-year-old males) of progressive renal insufficiency with eosinophilia and peripheral ischemic symptoms such as livedo reticularis and foot pain following percutaneous coronary intervention (PCI) for acute myocardial infarction. In the first case, we made a diagnosis of CCE based on clinical findings, which included deteriorating renal failure after PCI, peripheral eosinophilia, livedo reticularis, smoking history, uncontrollable hypertension, and severe atherosclerotic plaque of the aorta demonstrated by transesophageal echocardiography. In the second case, skin biopsy specimens confirmed a diagnosis of CCE.
In both cases, treatment with prostaglandins and statins was unsatisfactory. However, additional treatment with LDL apheresis (LDL-A) and corticosteroids improved the eosinophillia, livedo reticularis, foot pain and renal function, suggesting that this combined treatment may have a beneficial effect on CCE.
ϊγεγο 2006; 2(2), 115-120
Cholesterol Crystal Embolizm (CCE), corticosteroid, LDL apheresis
Reiko Okazaki, First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan