PAIN RELIEF AND CLINICAL IMPROVEMENT TEMPORALLY RELATED TO THE USE OFPENTOXIFYLLINE IN A PATIENT WITH DOCUMENTED CHOLESTEROL EMBOLI - A CASE-REPORT

A sixty-six-year-old man with known severe atherosclerosis was admitte d with painful feet and nonblanching purpuric lesions of his toes. He had undergone cardiac catheterization and coronary artery bypass five and three months, respectively, prior to admission. Initial treatment included: stopping the patient's lisinopril, increasing his nifedipine dose, and adding pentoxifylline 400 mg po tid. Within twenty-four hou rs pain was markedly decreased. Skin biopsy confirmed a diagnosis of c holesterol embolism. Pentoxifylline was stopped and intravenous hepari n therapy was initiated. Within twenty-four hours, pain returned. Nitr ol paste applied to the top of each foot had no effect. After forty-ei ght hours, pentoxifylline was restarted. Once again, pain relief was n oted within twenty-four hours, and after forty-eight hours both feet w ere visibly improved. Heparin and analgesics were discontinued. On the ninth hospital day, the patient was able to walk and was discharged t o home. The innocuous nature of the intervention combined with the pro mpt nature of the therapeutic response support a short trial of pentox ifylline in patients with cholesterol emboli who are not responding to other therapy.