[Unusual cause of chronic iron-deficiency anemia and insulin resistance: cholesterol embolism]

Area of Science:

• Cardiovascular Pathology
• Gastroenterology
• Endocrinology

Background:

• Cholesterol embolism disease (CED) is a rare condition with diverse clinical presentations.
• Digestive and endocrine manifestations are infrequently reported in CED.

Observation:

• A 73-year-old female patient presented with CED, initially identified through iron deficiency anemia and chronic digestive bleeding.
• The patient also exhibited significant insulin resistance.

Findings:

• Iron deficiency anemia as the sole initial symptom of CED is exceptionally rare.
• Histopathological examination of mucosal lesions is crucial for diagnosing CED, revealing characteristic cholesterol clefts.
• The co-occurrence of CED with major insulin resistance is novel, though atherosclerosis risk factors like diabetes are known.

Implications:

• This case underscores the polymorphous nature of CED and the need for thorough diagnostic investigation, including histopathology.
• The association with insulin resistance warrants further research into potential pancreatic or inflammatory mechanisms in CED.
• Recognizing rare presentations of CED is vital for timely diagnosis and management.