Higo Seiichiro, Hirama Akio, Ueda Kae, Mii Akiko, Kaneko Tomohiro, Utsumi Kouichi, Iino Yasuhiko, Katayama Yasuo
Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School, Japan.
J Nippon Med Sch. 2011;78(4):252-6. doi: 10.1272/jnms.78.252.
A 72-year-old man was admitted to our hospital because of progressive renal dysfunction persisting for 1.5 months. Physical examination showed livedo reticularis of the toes of both feet, peripheral edema, and gait disturbance due to the toe pain. The levels of blood urea nitrogen (50.0 mg/dL) and creatinine (2.81 mg/dL) were elevated, and eosinophilia (10%, 870/µL) was noted. A biopsy of the area of livedo reticularis revealed cholesterin crystals. The patient had not undergone angiography, anticoagulation therapy, or antithrombotic treatment. Idiopathic cholesterol crystal embolization was diagnosed. Transesophageal echocardiography revealed intimal thickening of the aorta and plaque. Oral steroid therapy was started because of the progressive renal dysfunction. After steroid therapy, the symptoms improved. Early diagnosis and treatment are important. Renal dysfunction is a common symptom in elderly patients. Cholesterol crystal embolization should also be considered as a cause of unexplained renal dysfunction, especially in such patients.
一名72岁男性因进行性肾功能不全持续1.5个月入住我院。体格检查发现双足趾网状青斑、外周水肿以及因趾痛导致的步态障碍。血尿素氮（50.0mg/dL）和肌酐（2.81mg/dL）水平升高，且有嗜酸性粒细胞增多（10%，870/µL）。网状青斑区活检发现胆固醇结晶。该患者未接受血管造影、抗凝治疗或抗血栓治疗。诊断为特发性胆固醇结晶栓塞。经食管超声心动图显示主动脉内膜增厚和斑块。由于进行性肾功能不全，开始口服类固醇治疗。类固醇治疗后症状改善。早期诊断和治疗很重要。肾功能不全是老年患者的常见症状。胆固醇结晶栓塞也应被视为不明原因肾功能不全的一个病因，尤其是在这类患者中。
