Eosinophilia and neuropathy after a percutaneous transluminal coronary angioplasty

History and clinical findings: A 76-year-old man was admitted for a coronar y angiography because of a postinfarction angina. Clinical examination was normal except a grade 2/6 systolic murmur and a slightly impaired vibration sense. Investigations: A slight anaemia, a slightly impaired renal function, and a slightly elevated cholesterol level could be found. The ECG showed a chron ic anterior myocardial infarction. In the coronary angiography a double ves sel disease was seen. Treatment and course: A percutaneous transluminal coronary angioplasty of t he left anterior descending artery was performed and four stents were impla nted. During the procedure a rush occurred in both legs following an appear ance of livedo reticularis. Renal function deteriorated and there was an ma rkedly increased number of eosinophils. With a new neurological check a mar ked peripheral neuropathy could be found. A biopsy of the sural nerve showe d a necrotizing granulomatous inflammation of the nerve and the surrounding small arteries. Several small arteries contained needle shaped crystal cle fts in their walls. The appearances were of multiple cholesterol emboli. Be sides treatment of pain an immunosuppressive therapy with prednisone (100 m g/d) and cyclophosphamide (50 mg/d) showed no improvement. The patient died 2 months after the diagnosis of cholesterol emboli. Conclusion: Typically, cholesterol embolism occurs in elderly men within th e eight weeks after arterial procedure. Diagnosis can be made only by histo logical examination. Cholesterol emboli syndrome may mimic systemic vasculi tis. Therapy trial of cholesterol emboli syndrome usually fails and mortali ty rate is high.