Key result
Cholesterol crystal embolism leads to fatal intestinal perforations in a CKD patient presenting with skin ulcers.
Why the study?
Skin ulcers in patients with chronic kidney disease may be an important diagnostic hallmark associated with several serious diseases, but diagnosis can be challenging.
Case Report (n=1)
Skin ulcers in patients with chronic kidney disease may serve as an important diagnostic hallmark for severe conditions like cholesterol crystal embolization.
Refractory skin ulcers may signal cholesterol crystal embolism in CKD; this case leaves open whether early recognition prevents fatal perforations.
A 66-year-old man was admitted to our hospital because of multiple refractory skin ulcers. Based on his severe systemic arterial calcification and severe calcium-phosphate imbalance due to severe kidney dysfunction, we initially considered calciphylaxis. However, a skin biopsy provided a diagnosis of cholesterol crystal embolization. Although we initiated hemodialysis, steroid treatment, and low-density lipoprotein-cholesterol apheresis, he died of multiple intestinal perforation. An autopsy showed cholesterol crystals occluding multiple organ arterioles. This case suggests that skin ulcers in patients with chronic kidney disease may be an important diagnostic hallmark and may be associated with several serious diseases.
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Kumakura et al. (2019) conducted a case report in Idiopathic Cholesterol Crystal Embolism with Chronic Kidney Disease (n=1). Hemodialysis, steroid treatment, and low-density lipoprotein-cholesterol apheresis was evaluated on Clinical outcome / Survival. A 66-year-old man with chronic kidney disease presenting with refractory skin ulcers was diagnosed with cholesterol crystal embolism but died of multiple intestinal perforations despite treatment.
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