摘要
本病例為61歲女性，本身有糖尿病，高血脂及冠狀動脈疾病好幾年，在接受心導管檢查，冠狀動脈氣球擴張術及抗凝血劑治療二個月後，雙腳底出現疼痛與網狀皮斑，且左腳底有輕度潰瘍。皮膚病變之病理組織檢查發現在網狀真皮有一條阻塞小動脈，內有針狀空隙，且周圍有纖維化。其臨床與病理皆為膽固醇栓塞之典型表現。本病例無血壓升高，腎功能惡化及其他症狀，且對PGE1之治療反應良好，屬於局限於皮膚及下肢且預後良好的末梢性膽固醇栓塞。臨床上，如果一中老年人，突然出現雙足網狀皮斑及潰瘍，先前有糖尿病、高血壓、高血脂，且最近曾接受血管手術或是心血管檢查者，宜強烈懷疑膽固醇栓塞，並僅快做進一步檢查及治療。
關鍵字
無資料並列摘要
We reported a typical case of cutaneous cholesterol embolism (CE) occurring in a 61-year-old female with a history of diabetes mellitus, hyperlipidemia and coronary artery disease for which she received cardiac catheterization and angioplasty 3 months previousl. Two months after catheterization, she developed multiple painful, erythematous and purpuric reticulate lesions on her both soles with shallow ulceration on her left sole. Pathological examination revealed a small artery in reticular dermis occluded by needle-shaped clefts, characteristic of CE. There was no systemic complication. The cutaneous CE resolved after intravenous PGE1. This was a case of peripheral CE which is localized to the skin and has a good prognosis. The visceral CE is associated with high mortality rates mostly due to cardiac or renal complications. The possible precipitating factors for CE in this patient included diabetes mellitus, hyperlipidemia, angioplasty and heparin therapy. CE should be suspected in elderly patients with diabetes mellitus, hypertension, hyperlipidemia who have a sudden onset of reticulate violaceous erythema on the soles after vascular surgery or invasive angiographic procedures.
延伸閱讀
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