A case of cutaneous cholesterol embolism: JAMA
A man in his 60s presented to the emergency department for left flank pain of 1 week’s duration. His medical history included severe peripheral arterial disease and a remote history of ruptured abdominal aortic aneurysm.

Three months before presentation, he underwent percutaneous endovascular stenting of a left popliteal artery aneurysm. Physical examination of the left flank showed a well-defined 5 × 12-cm purpuric patch with a darker stellate patch within it (Figure, A). Two punch biopsy specimens were obtained (Figure, B and C).

Histopathologic examination of both biopsies revealed intravascular needle-shaped clefts within the lumina of blood vessels (Figure, B). Eccrine coil and duct necrosis were seen within the dermis (Figure, C). The clinical presentation and histologic findings confirmed the diagnosis of spontaneous cholesterol embolism (CE).

Cholesterol embolism syndrome (CES) occurs when cholesterol crystals break off from unstable atherosclerotic plaques in major arteries and occlude downstream arterioles, causing tissue ischemia.1,2 Usually, CES is seen in men 50 years or older; common comorbidities include diabetes mellitus, hyperlipidemia, hypertension, history of tobacco abuse, and peripheral vascular disease.

Know more here: https://jamanetwork.com/journals/jamadermatology/article-abstract/1922023
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