Fatal Course of Cutaneous Cholesterol Embolization Syndrome: A Case Report.

Area of Science:

• Vascular Surgery
• Dermatology
• Nephrology

Background:

• Cholesterol embolization syndrome (CES) is an underdiagnosed complication following endovascular interventions and thrombolytic therapy.
• Emboli originating from the aortic wall can affect abdominal organs, skin, and extremities.

Observation:

• A patient presented with progressive skin ulceration and necrosis of the lower extremities, initially unresponsive to endovascular treatment.
• Initial skin biopsies did not reveal the cause, delaying diagnosis.

Findings:

• A second biopsy confirmed Cholesterol Embolization Syndrome (CES).
• Despite treatment with prednisone and successful arterial revascularization, skin necrosis progressed rapidly.

Implications:

• This case underscores the importance of considering CES in patients with unexplained skin necrosis after vascular procedures, even with seemingly optimal arterial status.
• Early diagnosis and intervention are critical to prevent severe outcomes such as limb amputation, sepsis, and renal failure.
• Highlights the need for heightened clinical suspicion and diagnostic vigilance for CES in relevant patient populations.