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Hemorrhagic panniculitis caused by delayed microemboli from intravascular device

Curtis Lamar Hardy1, Jonathan S Glass2, Timothy Sorrells3

  • 1Department of Graduate Medical Education, Naval Medical Center Portsmouth, Portsmouth, Virginia.

JAMA Dermatology
|October 2, 2014
PubMed
Abstract

Insights

Delayed microemboli from intravascular device polymer coatings can cause panniculitis, mimicking other conditions. Early identification of these subtle, gradual breakdowns is crucial to prevent severe patient harm.

Area of Science:

  • Vascular Surgery
  • Dermatology
  • Materials Science

Background:

  • Intravascular devices, such as stents, are crucial in treating aortic aneurysms.
  • Breakdown of these devices can lead to delayed microemboli, presenting with subtle symptoms.
  • Microemboli can mimic common disorders and, if undetected, cause significant morbidity and mortality.

Observation:

  • A patient presented with ecchymoses and subcutaneous nodules months after aortic aneurysm repair.
  • Skin biopsy revealed hemorrhage and panniculitis with amorphous deposits.
  • Analysis identified these deposits as hydrophilic polymer consistent with device coatings.

Findings:

  • This case highlights delayed microembolization from hydrophilic polymer coatings on intra-arterial stents.
  • The polymer breakdown occurred gradually, months after the initial aortic aneurysm repair.
  • The microemboli induced a panniculitis, a form of skin inflammation.

Implications:

  • Delayed microembolization from intravascular device coatings is an underrecognized clinical entity.
  • Clinical suspicion for polymer microemboli is essential, even months after device placement.
  • Prompt diagnosis and management are vital to prevent catastrophic outcomes associated with undetected microembolization.

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