[Massive rhabdomyolysis: an uncommon complication of cholesterol embolization syndrome]

Abstract

A 79-year-old man with atherosclerosis presented blue toes and livedo reticularis. The patient had eroded aortic atheromatous plaques, and cholesterol embolization syndrome was suspected. An endovascular technique to exclude sources of cholesterol emboli was however performed. The patient immediately presented with severe muscle pain and total functional disability of lower limbs, new ischemic lesions of toes, anal and genital necrosis, and a livedo extended up to the abdomen. A massive rhabdomyolysis occurred associated with acute kidney injury and hyperkaliemia treated by continuous renal replacement therapy with regional citrate anticoagulation. Steroids have been introduced and renal function improved. Cholesterol crystals were also found on a skin biopsy, performed before endovascular procedure.

Keywords: Anuric acute renal failure; Cholesterol embolization syndrome; Corticosteroids; Corticothérapie; Insuffisance rénale aiguë anurique; Lésions cutanées de livedo; Maladie des emboles de cholestérol; Massive rhabdomyolysis; Renal replacement therapy with citrate anticoagulation; Rhabdomyolyse massive; Skin lesions of livedo; Épuration extrarénale avec anticoagulation au citrate.