A cholesterol crystal embolism patient treated with LDL apheresis and corticosteroids

Abstract

After complaining of general fatigue, an 81-year-old woman with hypertension and chronic kidney disease who was being treated by her family physician was admitted to another hospital; she was then transferred to our hospital because of oliguria on day6. The serum creatinine level was 3.61mg/dL and blood urea nitrogen level was 94.2mg/dL. Physical examination on admission revealed cyanosis of the toes. We started renal replacement therapy to control acute kidney injury and heart failure. Skin biopsy of the acrocyanotic toes led to a diagnosis of cholesterol crystal embolism. In addition to the administration of prostaglandin and statins, we performed 10 sessions of low-density lipoprotein apheresis (LDL-A). Following LDL-A, the blue acrocyanotic toes and pain from improved markedly, but the renal function did not improve. Oral glucocorticoids (prednisolone 20mg/day) were started on day48. With these therapies, the renal function improved. Final hemodialysis (HD) was performed on day97, and then HD was discontinued. In this report, we also describe laboratory findings and outcomes of 14 patients diagnosed with cholesterol crystal embolism in our hospital.