A catastrophic case of idiopathic cholesterol crystal embolism with multiple lethal complications: A labyrinth underneath the diagnosis of skin ulcers in chronic kidney disease patients

Satoshi Kumakura, Takashi Nakamichi, Nonoka Suzuki, Shu Yamakage, Ayako Ishikawa, Emi Fujikura, Satoko Sato, Takeshi Aoki, Hiroaki Musha, Katsuko Kikuchi, Tasuku Nagasawa, Hiroshi Sato, Sadayoshi Ito, Mariko Miyazaki

Research output: Contribution to journalArticlepeer-review

Abstract

A 66-year-old man was admitted to our hospital because of multiple refractory skin ulcers. Based on his severe systemic arterial calcification and severe calcium-phosphate imbalance due to severe kidney dysfunction, we initially considered calciphylaxis. However, a skin biopsy provided a diagnosis of cholesterol crystal embolization. Although we initiated hemodialysis, steroid treatment, and low-density lipoprotein-cholesterol apheresis, he died of multiple intestinal perforation. An autopsy showed cholesterol crystals occluding multiple organ arterioles. This case suggests that skin ulcers in patients with chronic kidney disease may be an important diagnostic hallmark and may be associated with several serious diseases.

Original languageEnglish
Pages (from-to)1753-1758
Number of pages6
JournalInternal Medicine
Volume58
Issue number12
DOIs
Publication statusPublished - 2019

Keywords

  • Arteriolosclerosis
  • Calciphylaxis
  • Cholesterol crystal embolism
  • Chronic kidney disease
  • Multiple intestinal perforation
  • Skin ulcer

ASJC Scopus subject areas

  • Internal Medicine

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