Cholesterol Crystal Embolism Induced by Direct Factor Xa inhibitor: A First Case Report

Hideaki Oka; Taro Kamimura; Yuki Hiramatsu; Kento Fukumitsu; Rei Iwata; Mika Kondo; Yutaro Hirashima; Seishi Aihara; Atsumi Harada; Kazuhiko Tsuruya

doi:10.2169/internalmedicine.8660-16

This article has now been updated. Please use the final version.

Cholesterol Crystal Embolism Induced by Direct Factor Xa inhibitor: A First Case Report

Hideaki Oka, Taro Kamimura, Yuki Hiramatsu, Kento Fukumitsu, Rei Iwata, Mika Kondo, Yutaro Hirashima, Seishi Aihara, Atsumi Harada, Kazuhiko Tsuruya

Author information

Hideaki Oka
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
Taro Kamimura
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Yuki Hiramatsu
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Kento Fukumitsu
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Rei Iwata
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Mika Kondo
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Yutaro Hirashima
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Seishi Aihara
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Atsumi Harada
Division of Kidney Center, Matsuyama Red Cross Hospital, Japan
Kazuhiko Tsuruya
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Japan

Keywords: acute kidney injury, cholesterol crystal embolism, direct oral anticoagulants, edoxaban, renal failure, Xa inhibitors

JOURNAL OPEN ACCESS Advance online publication

Article ID: 8660-16

DOI https://doi.org/10.2169/internalmedicine.8660-16

The final version of this article is now available: Vol. 57 (2018), No. 1 pp. 71-74

Details

Abstract

An 80-year-old man presented at our hospital with renal failure. He had been treated with edoxaban, an oral direct factor Xa inhibitor, for deep vein thrombosis for 10 months prior to admission. Although the pulses in his bilateral pedal arteries were palpable, cyanosis was present in the bilateral toes. Laboratory data indicated azotemia and eosinophilia. A skin biopsy confirmed a diagnosis of cholesterol crystal embolism (CCE). Because no invasive vascular procedure was performed, we assumed that CCE was related to edoxaban. To the best of our knowledge, this is the first case report suggesting CCE induced by an Xa inhibitor.

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