Relapsing digital ulcers

A 72-years-old male patient is described who presented with relapsing, digital ulcers on both feet, accompanied by digital cyanosis ("purple toes"). All episodes occurred 5 months after starting coumarin treatment for chronic atrial fibrillation and low output failure. Massive mural thrombosis was discovered of the entire abdominal aorta. Because of the clinical picture, together with progressive renal failure and persistent eosinophilia, cholesterol embolization from an ulcerated atherosclerotic plaque within the mural thrombus was highly suspected. Besides the clinical presentation of our patient, the spectrum of cholesterol embolization is much wider. The role of coumarin therapy is still speculative. Numerous reports however, indicate a potential role in precipitating the syndrome. The only therapy available consists of removing the source whenever possible.