LDL apheresis followed by corticosteroid therapy as a possible treatment of cholesterol crystal embolism

Abstract

A 66-year-old man with an abdominal aneurysm who developed renal failure and had blue toes after coronary angiography was transferred to our hospital, and cholesterol crystal embolism was diagnosed by renal and skin biopsies. After the initiation of low-density lipoprotein apheresis (LDL-A) following short-term corticosteroid therapy, in pain and the blueness in the toes disappeared rapidly, and inflammation decreased, but after the discontinuance of these therapies renal function and inflammation worsened again. Following the re-administration of corticosteroid, the inflammation disappeared and renal function gradually recovered. Although LDL-A is an effective treatment for the control of pain due to blue toes, its effect is additive. However, corticosteroid is a possible treatment for cholesterol crystal embolism, particularly in patients with severe inflammatory reaction, which suggests the possible participation of inflammatory or immunological factors in the progression of cholesterol crystal embolism.