BOF: 2.55
A 67-year-old male from Thailand was admitted with a
history of severe crushing central chest pain. His ECG showed ST elevation in
the anterior chest leads and he was treated with tPA, which resulted in
resolution of the ECG changes.
Over the next few days he had several episodes of
pulmonary oedema, his blood pressure began to rise and he was noted to have a
petechial rash over his feet.
His renal function began to deteriorate and he was
ultimately commenced on haemodialysis. His blood tests showed an elevated
eosinophil count of 1.13×109/l (normal range <0.40)
In this patient underlying condition is:
a)
Polyarteritis nodosa
b)
Henoch-Schonlein purpura
c)
Cholesterol embolisation syndrome
d)
Beurger’s disease
e)
Tropical pulmonary eosinophilia
Answer:
c)
The cholesterol embolisation syndrome is a serious
multisystem disorder that arises in individuals with generalised atheroma. It
is caused by destabilisation of cholesterol plaques, which leads to release of
cholesterol crystals. These crystals circulate and get lodged in small blood
vessels with consequent infarction of tissue. The crystals also provoke an
inflammatory response in the affected vessel with consequent fibrosis of the
vessels. This may occur months after the in initial insult. The inflammatory
response is thought to account for the eosinophilia, which is often seen in
this condition.
Characteristics of cholesterol embolisation syndrome:
·
Livedo reticularis
·
Acute renal failure
·
Eosinophilia
Risk factors for cholesterol embolism:
·
Hypertension
·
Diabetes mellitus
·
Aortic aneurysm.
Precipitating factors:
·
Angiography
·
Anticoagulation
·
Thrombolysis
·
Vascular surgery (including coronary artery bypass grafting)
