Abstract Development of cholesterol crystal embolism (CCE) following an aortic dissection in the absence of endovascular procedures or anticoagulation therapy is rare. We report a case of a 68-year-old man who developed an aortic dissection and acute kidney injury (AKI) associated with the delayed-onset CCE. The patient developed an acute type B aortic dissection and was managed conservatively without any endovascular interventions or anticoagulation. Four weeks after the aortic dissection, the livedo reticularis on his lower extremities and purple toes appeared. One week later (five weeks after onset), he presented with AKI (serum creatinine level was 6.11 mg/dL) and peripheral eosinophilia. A skin biopsy from the lower leg revealed arterioles occluded by cholesterol clefts with surrounding mononuclear cell infiltration, confirming the diagnosis of CCE. Given the progressive deterioration of kidney function, oral prednisolone (PSL) was initiated. Following treatment, his kidney function improved, allowing him to avoid hemodialysis, with his serum creatinine level eventually recovering to 1.9 mg/dL. This case suggests that considering the diagnosis of delayed-onset CCE is important in patients with a recent history of aortic dissection presenting with AKI, even in the absence of typical iatrogenic triggers. Furthermore, corticosteroid therapy may be considered as a treatment option for CCE-associated AKI.
Nakada et al. (Fri,) studied this question.