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Updated: Dec 27, 2025

Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
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[Cholesterol crystal embolism mimicking a DRESS].

M Dumas1, R Flipo1, L Blum1

  • 1Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France.

La Revue De Medecine Interne
|February 25, 2020
PubMed
Summary
This summary is machine-generated.

Cholesterol crystal embolism (CCE) can mimic drug reaction with eosinophilia and systemic symptoms (DRESS). This case highlights CCE presenting as erythroderma, emphasizing the importance of considering CCE in such presentations.

Keywords:
Cholesterol crystal embolismCutaneous rashEmboles de cristaux de cholestérolExanthèmeHyper eosinophiliaHyper-éosinophilie

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Area of Science:

  • Nephrology
  • Dermatology
  • Pathology

Background:

  • Cholesterol crystal embolism (CCE) can manifest with dermatologic symptoms due to cholesterol crystal deposition in cutaneous arteries.
  • Erythroderma is a potential clinical presentation of CCE.
  • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe adverse drug reaction that can present with erythroderma and eosinophilia.

Observation:

  • A 66-year-old woman presented with erythroderma and acute renal failure after starting allopurinol.
  • Elevated creatinine and marked hypereosinophilia (HE) were noted.
  • The REGISCAR score helped exclude Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Findings:

  • Chronic hypereosinophilia predated allopurinol use.
  • Renal biopsy confirmed Cholesterol Crystal Embolism (CCE).
  • The patient's presentation mimicked DRESS syndrome.

Implications:

  • This case is the first to describe a DRESS-like presentation of CCE.
  • Clinical manifestations were attributed to hypereosinophilia rather than arterial occlusion.
  • Highlights the importance of considering CCE in patients with unexplained erythroderma and eosinophilia.