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Cholesterol Embolism —A Case Report—
Yuh-Ru Huang J.Yu-Yun Lee Hamm-Ming Sheu
Dermatol Sinica 20: 123-127, 2002

We reported a typical case of cutaneous cholesterol embolism (CE) occurring in a 61-year-old female with a history of diabetes mellitus, hyperlipidemia and coronary artery disease for which she received cardiac catheterization and angioplasty 3 months previously. Two months after catheterization, she developed multiple painful, erythematous and purpuric reticulate lesions on her both soles with shallow ulceration on her left sole. Pathological examination revealed a small artery in reticular dermis occluded by needle-shaped clefts, characteristic of CE. There was no systemic complication. The cutaneous CE resolved after intravenous PGE1. This was a case of peripheral CE which is localized to the skin and has a good prognosis. The visceral CE is associated with high mortality rates mostly due to cardiac or renal complications. The possible precipitating factors for CE in this patient included diabetes mellitus, hyperlipidemia, angioplasty and heparin therapy. CE should be suspected in elderly patients with diabetes mellitus, hypertension, hyperlipidemia who have a sudden onset of reticulate violaceous erythema on the soles after vascular surgery or invasive angiographic procedures.

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