A Case of Cholesterol Embolism Syndrome (CES): clinical diagnosis, management, and follow-up of cutaneous involvement after percutaneous coronary intervention

A Case of Cholesterol Embolism Syndrome (CES): clinical diagnosis, management, and follow-up of cutaneous involvement after percutaneous coronary intervention ଝ Dear Editor,A 56-year-old male with a decade-long medical history marked by type 2 diabetes mellitus, hyperlipidemia, hypertension, and coronary artery disease underwent Percutaneous Coronary Intervention (PCI) one month ago.The patient presented to the emergency department with a three-day history of toe pain.Physical examination revealed the presence of blue reticulated patches on the abdomen, back, thighs, lower extremities, and feet, occasionally accompanied by purpuric plaques.The morphological diagnosis of the skin was livedo reticularis and reticular purpura (Fig. 1).On palpation, the toes were noted to be cold and painful.The dorsalis pedis and posterior tibial pulses were found to be within normal parameters.Laboratory tests revealed elevated levels of eosinophils, triglycerides, serum creatinine, and urea, along with decreased levels of complement, prolonged Activated Partial Thromboplastin Time (APTT), and increased plasma D-dimer.The peak creatinine level was 84.9 mol/L (reference range: 53---123 mol/L).The inflammatory markers revealed an erythrocyte sedimentation rate (ESR) of 37 mm/h (reference range: 0---15 mm/h) and C-Reactive Protein (CRP) of 27.53 mg/L (reference range: < 10 mg/L).Urinalysis revealed a peak total urinary protein excretion of 477 mg over a 24 hour period, with no other significant abnormalities detected.A subsequent nephrology consultation recommended hormone therapy if deemed necessary, in addition to dynamic monitoring of coagulation function, complete blood count, urinalysis, and urine output changes.Bilateral lower extremity arterial Doppler ultrasound revealed thickened, rough vessel walls with ଝ Study conducted at the