2022 Volume 21 Issue 4 Pages 283-287
A 36-year-old man underwent coil embolization for a cerebral arteriovenous malformation. Three days later, the patient developed painful dendritic purpura on his right sole and toes, which was suspected of cholesterol crystal embolism (CCE). Skin biopsy showed intravascular mucous-like lamellated basophilic structures in the middle layer of the dermis, and he was diagnosed with hydrophilic polymer embolism (HPE). The skin lesions improved spontaneously within 10 days. Hydrophilic polymers are used as coating agents for endovascular treatment devices such as catheters. HPE is caused by the polymer coating peeling off ; thus, contact between the devices and the calcified vessel walls with devices increases the risk of HPE. All reported HPE cases were elderly people with the arteriosclerotic disease ; however, the present patient had a congenital arteriovenous malformation and was young. It may be difficult to distinguish between HPE and CCE clinically, so a biopsy is necessary for patients who develop livedo reticularis or purpura in the lower extremities after endovascular treatment. is necessary for patients who develop livedo reticularis or purpura in the lower extremities after endovascular treatment. Skin Research, 21 : 283-287, 2022
