[Cholesterol embolization after intravenous streptokinase therapy in acute myocardial infarction]

The cholesterol embolization syndrome occurs in patients with extensive atherosclerotic disease as a consequence of the showering of cholesterol-rich material from ulcerated atheromatous plaques into the arterial circulation. Cholesterol embolization has been described after angiographic procedures, vascular surgery or anticoagulation therapy and may cause manifestations from multiple organ systems. Only recently, this syndrome has been reported following intravenous thrombolytic treatment for myocardial infarction. We describe one patient who developed cholesterol embolization syndrome with extensive peripheral manifestations after intravenous streptokinase treatment for myocardial infarction. He developed livedo reticularis, with multiple symmetrical skin necrosis and ulcerations below the umbilical region. Repeated histology from ulcerations failed to demonstrate cholesterol crystals in thromboses, only revealing ischemic changes and lack of vasculitis. The patient died of a new myocardial infarction six months after the streptokinase treatment. The abdominal aorta below the renal arteries was covered by extensive atheromatous masses, with partly ulcerated intima.