ABSTRACT
The skin lesions shown here developed in a 45-year-old man with hypertension after percutaneous renal angiography. Complete blood count shows eosinophilia. What is this syndrome?
a. Antiphospholipid antibody syndrome b. Warfarin necrosis syndrome c. Scleroderma renal crisis d. Hepatorenal syndrome e. Blue toe syndrome
• After angiography, atheroembolism is estimated to occur in up to 30% of patients, according to autopsy studies. However, the syndrome may occur without an obvious precipitating event. Many cases remain clinically silent
• Worsening renal function (67%-85%), increasing hypertension (43%-66%), skin changes (65%), abdominal pain (24%-37%), and leg pain (15%-28%) are the most common clinical sequelae
• Blue or purple toes and livedo reticularis are the most common skin changes, both of which are visible on the images shown on the previous page. Necrosis of digits may occur
• Fever, myalgias, headache, and weight loss are not uncommon. Gross hematuria, hematochezia, penile gangrene, and spinal cord infarction have been described in this syndrome
• Eosinophilia, eosinophiluria, hypocomplementemia, and increased erythrocyte sedimentation rate have been noted on laboratory investigations
• Definitive diagnosis is made by finding cholesterol clefts on biopsy of affected tissue
• There is no clearly effective treatment. Recurrences are common
• Prognosis is poor. Most deaths result from coronary artery disease within several years of embolization
