Cholesterol embolism of bone marrow clinically masquerading as systemic or metastatic tumor

A case of cholesterol embolism of bone marrow, concerning the pelvis and lumbar region and clinically masquerading as systemic disease or metastatic tumor, is reported in an 82-year-old man hospitalized for acute onset of reddish purple nodules on the legs and toes, intense myalgia and dorsal vertebral bone pain. The clinical manifestations leading to consideration of a systemic disease or metastatic tumor were the abnormal bone scintigraphic findings of the pelvis and lumbar region, the elevation of serum alkaline and acid phosphatase and the increase of the bone isoenzyme fractions. The diagnosis of cholesterol embolism was explained by the histological findings of bone marrow biopsy which showed microinfarctions of bone marrow with an osteoproductive and reparative process, and presence of cholesterol clefts.