Takahashi Toshiyuki, Konta Tsuneo, Nishida Wakako, Igarashi Akira, Ichikawa Kazunobu, Kubota Isao
First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata.
Intern Med. 2003 Dec;42(12):1206-9. doi: 10.2169/internalmedicine.42.1206.
A 65-year-old man developed acute renal failure with eosinophilia two weeks after a coronary bypass operation and angiography. Renal biopsy revealed cholesterol crystal embolism (CCE) in glomeruli and arterioles. Low-dose corticosteroid therapy failed to recover the renal function; further deterioration of renal function and peripheral ischemic symptoms such as livedo reticularis and blue toes occurred. However, steroid pulse therapy successfully attenuated CCE-induced renal failure and eosinophilia. It is suggested that steroid pulse therapy might be effective to treat CCE-induced renal failure and eosinophilia could be a useful marker for activity of CCE.
一名65岁男性在冠状动脉搭桥手术和血管造影术后两周出现急性肾衰竭并伴有嗜酸性粒细胞增多。肾活检显示肾小球和小动脉中有胆固醇结晶栓塞（CCE）。低剂量皮质类固醇治疗未能恢复肾功能；肾功能进一步恶化，出现了网状青斑和蓝趾等外周缺血症状。然而，类固醇冲击疗法成功减轻了CCE引起的肾衰竭和嗜酸性粒细胞增多。提示类固醇冲击疗法可能对治疗CCE引起的肾衰竭有效，嗜酸性粒细胞增多可能是CCE活动的一个有用标志物。
