Cholesterol crystal embolism mimicking a DRESS

Clinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DR...

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Bibliographic Details
Published in:La revue de medecine interne 2020-04, Vol.41 (4), p.275
Main Authors: Dumas, M, Flipo, R, Blum, L, Jouzel, C, Brochériou, I, Begon, E
Format: Article
Language:fre
Subjects:
Aged
Cholesterol - chemistry
Cholesterol - metabolism
Crystallization
Diagnosis, Differential
Drug Hypersensitivity Syndrome - diagnosis
Embolism, Cholesterol - complications
Embolism, Cholesterol - diagnosis
Eosinophilia - diagnosis
Eosinophilia - etiology
Exanthema - diagnosis
Exanthema - etiology
Female
Humans
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Summary:Clinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DRESS). A 66 year-old woman presented with erythroderma few months after initiation of allopurinol. Acute renal failure was present with elevation in plasma creatinine concentration (523μmol/L) and hypereosinophilia (HE) (5666/mm ). Finally, the REGISCAR score helped to rule out DRESS diagnostic. Past blood-count tests were analyzed revealing chronic HE present before allopurinol initiation. Renal biopsy identified CCE. This case is the first to report a DRESS like presentation of CCE. Clinical findings are secondary to HE and not to occlusion of cutaneous arteries.
ISSN:1768-3122
DOI:10.1016/j.revmed.2020.01.007