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[Association of disseminated intravascular coagulation and cutaneous crystal cholesterol emboli (author's transl)]
Insights
This case study explores cutaneous cholesterol emboli and disseminated intravascular coagulation (D.I.C.) in a 72-year-old man. It examines two hypotheses for their co-occurrence, involving emboli triggering D.I.C. or vice versa.
Area of Science:
- Vascular pathology
- Hematology
Background:
- Cholesterol crystal emboli (CCE) and disseminated intravascular coagulation (D.I.C.) are serious conditions.
- Their co-occurrence presents diagnostic challenges.
Observation:
- A 72-year-old male presented with cutaneous manifestations.
- Clinical signs included livedo reticularis, purpura, acral cyanosis, and hemorrhagic bullae.
- Biopsies revealed cholesterol clefts in arterioles and intravascular fibrin thrombi.
Findings:
- The patient exhibited hemostatic abnormalities consistent with D.I.C.
- Heparin therapy proved effective, suggesting a thrombotic component.
- Evidence supported both CCE and D.I.C. hypotheses.
Implications:
- Two pathogenic pathways are proposed: CCE initiating D.I.C. via thromboplastic substances, or D.I.C. provoking CCE through fibrinolysis of atheromatous plaque thrombi.
- Understanding this interplay is crucial for accurate diagnosis and treatment of complex vascular and coagulation disorders.
Abstract:
The case of a 72-year-old man with cutaneous cholesterol emboli in association with disseminated intravascular coagulation (D.I.C.) is described. Favouring the crystal cholesterol emboli hypothesis are the livedo reticularis and purpura in the lower extremities, palpable pulses, arterioles containing cholesterol clefts. Favouring the hypothesis of D.I.C. are the purpuric lesions on the ears and nose, acral cyanosis and haemorrhagic bullae on the hands, intravascular fibrinous thrombi, hemostatic abnormalities and the efficacy of heparin. Two pathogenic hypotheses are discussed: 1) "spontaneous" crystal cholesterol emboli have started a D.I.C. following the release of thromboplastic substances; 2) a D.I.C. with its secondary fibrinolysis has provoked a dissolution of the thrombosis which covered the atheromatous plaques and started cholesterol crystal emboli.