Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
CASE REPORTS
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 KumakuraTakashi NakamichiNonoka SuzukiShu YamakageAyako IshikawaEmi FujikuraSatoko SatoTakeshi AokiHiroaki MushaKatsuko KikuchiTasuku NagasawaHiroshi SatoSadayoshi ItoMariko Miyazaki
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JOURNALS OPEN ACCESS

2019 Volume 58 Issue 12 Pages 1753-1758

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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.

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© 2019 by The Japanese Society of Internal Medicine
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