コレステロール結晶塞栓症（CCE）ステロイド療法とLDLアフェレーシス併用の効果

Cholesterol crystal embolism (CCE) is a systemic disorder caused by microshowers of cholesterol crystals. It brings about decreased microcirculation and is manifested in various organs including the kidneys, skin, brain and extremities. Cholesterol microshowers are thought to occur in about 50% of invasive vascular procedures, but most cases are clinically silent. CCE has a high mortality rate, but there are as yet no established methods for managing it. We report two cases (63-year-old and 73-year-old males) of progressive renal insufficiency with eosinophilia and peripheral ischemic symptoms such as livedo reticularis and foot pain following percutaneous coronary intervention (PCI) for acute myocardial infarction. In the first case, we made a diagnosis of CCE based on clinical findings, which included deteriorating renal failure after PCI, peripheral eosinophilia, livedo reticularis, smoking history, uncontrollable hypertension, and severe atherosclerotic plaque of the aorta demonstrated by transesophageal echocardiography. In the second case, skin biopsy specimens confirmed a diagnosis of CCE. In both cases, treatment with prostaglandins and statins was unsatisfactory. However, additional treatment with LDL apheresis (LDL-A) and corticosteroids improved the eosinophillia, livedo reticularis, foot pain and renal function, suggesting that this combined treatment may have a beneficial effect on CCE.