2 İstanbul Eğitim ve Araştırma Hastanesi, Tıbbı Patoloji Bölümü, İSTANBUL
DOI : 10.5146/jcpath.2019.42 Aim: Cholesterol embolization syndrome is a complication of widespread atherosclerosis in which cholesterol crystals break off from atherosclerotic plaques and occlude small arteries and arterioles. The aim of this report is to draw attention to consider cholesterol embolism in differential diagnosis of patients who present with skin lesion such as livedo reticularis and purpura after coronary angiography, and to necessity to examine all specimens by serial sectioning to identify cholesterol clefts in pathological examination.
Case: Two male patients that visited the dermatology outpatient clinic with complaints of redness and pain in their lower extremities presented with reticular purpuric patches on dermatological examination. Both patients reported history of recent coronary angiography. Preliminary diagnosis of cholesterol embolism was made, and punch biopsy samples were examined by serial sectioning. Cholesterol clefts were identified by histopathological examination of the specimens, and diagnosis of cholesterol embolism was made. No additional organ involvement other than cutaneous involvement was detected.
Conclusion: The lack of distinctive clinical findings and the need for histopathological examination for definitive diagnosis often lead to underdiagnosis of cholesterol embolism. Cholesterol embolism must be considered in the differential diagnosis of the patients who present with skin lesions like livedo reticularis and purpura after angiography. All tissue samples should be examined by serial sectioning for accurate diagnosis.
Anahtar Kelimeler : Cholesterol, Emboli, Angiography, Livedo reticularis, Purpura