Cutaneous cholesterol embolization.

Area of Science:

• Dermatology
• Vascular Medicine
• Pathology

Background:

• Cutaneous cholesterol embolization syndrome (CCES) results from cholesterol emboli dislodged from atherosclerotic plaques.
• CCES is often iatrogenic, linked to vascular procedures, anticoagulation, or thrombolytic therapy.
• Kidneys, gastrointestinal tract, and skin are the most frequently affected organs.

Observation:

• Two cases of CCES are presented: a 74-year-old with acute chest pain and a 69-year-old with hyperglycemia, hyperlipidemia, and hypertension.
• Patients developed livedo reticularis, skin necrosis, and, in one case, impaired renal function and cyanotic toes.
• Skin biopsies confirmed cholesterol clefts in small arteries and arterioles.

Findings:

• Histologic examination of skin biopsies revealed characteristic cholesterol clefts within small arteries and arterioles.
• Clinical presentation included livedo reticularis, progressing to necrotic skin lesions in the lumbar region, hips, and lower extremities.
• Both patients required debridement of necrotic tissue and secondary wound healing.

Implications:

• Accurate diagnosis of CCES hinges on integrating clinical presentation with histopathological findings.
• A multidisciplinary approach is crucial for managing CCES, particularly when multiple organ systems are involved.
• Prompt diagnosis and management are essential to prevent further embolic events and complications.