[Cholesterol crystal embolism mimicking a DRESS]

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.