The Role of Statins on the Outcomes on the Cholesterol Embolism Syndrome with Secondary Vasculitis-A Case Report and Review of the Literature

The cholesterol embolization syndrome (CES) is a potentially severe complication of atherosclerosis, caused by embolization of atherosclerotic plaques, most frequently after vascular surgery or endovascular procedures. The clinical presentation closely mimics that of systemic vasculitides hence it should be considered in the differential diagnosis in patients with suspected vasculitis. Skin lesions (e.g. acrocyanosis, blue toe syndrome, livedo reticularis, purpura, nodules, ulcerations, gangrene) are almost invariably present and usually an early sing of CES. Rare reports of CES presenting as secondary necrotizing vasculitis emphasize the need for careful pathohistological examination of affected tissue to obtain the correct diagnosis, and choose the optimal treatment strategy. We report a case of a patient with spontaneous CES with clinical features of necrotizing small vessel vasculitis suggestive of polyarteritis nodosa, and present a thorough literature review of the nine cases of CES with secondary necrotizing vasculitis reported thus far. Based on the available data, bearing in mind their paucity, we suggest co-medication with statins may be organor even life-saving in this setting.