Which clinical history findings are characteristic of cutaneous cholesterol emboli (CCE)?

Updated: Apr 12, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Cholesterol emboli is a rare potentially devastating complication of atherosclerosis, usually appearing as an iatrogenic event in a vascular procedure in the course of anticoagulant or thrombolytic therapy or after trauma. [21] Waves of emboli may produce end-organ failure, and include the blue toe syndrome. [22] In addition to describing the typical cutaneous signs of CCE, patients also often report the following:

  • Repetitive bouts of sudden spontaneous severe pain: The character of the pain has been described as tightness, burning, stinging, or soreness.

  • Myalgias

  • Claudication in the lower half of the body that may be exacerbated by cold or dependency

Numbness, coolness, and paresthesias of the extremities have also been reported.

According to Fukumoto in 2003, the diagnosis of CCE can be made when patients who undergo left-sided heart catheterization have peripheral cutaneous involvement (LR, blue toe syndrome, and digital gangrene) or renal dysfunction. [23] Elevated preprocedure plasma levels of C-reactive protein are linked with subsequent CCE in patients who undergo vascular procedures.

Cholesterol emboli may also be evident as the purple toes syndrome following stroke thrombolysis and warfarin therapy. [24]

Thus, the cholesterol embolization syndrome is a rare, potentially fatal disorder due to emboli of cholesterol crystals from atherosclerotic plaques, the signs and symptoms of which may be initially insidious and unrecognized. [25] However, it may occur in a less dramatic form as a mild cutaneous subtype. [26] It can be viewed as one of the syndromes affecting both skin and eye. [27] Multiple refractory cutaneous ulcers with chronic kidney disease may be a diagnostic sign of widespread, potentially lethal cholesterol embolization. [28]

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