An unusual cause of trash feet

Q1: What is the clinical diagnosis? What could be the cause of the ulceration and gangrene in the feet?

The condition is cholesterol crystal embolisation. The ulceration and gangrene in the feet have resulted from catheter manipulation during cardiac angiography and caused occlusion of the small arteries in the feet.

The triad of thigh and foot pain, livedo reticularis, and intact peripheral pulses is considered to be pathognomonic for cholesterol embolisation.

Q2: How can the diagnosis be confirmed?

An eosinophilia, raised erythrocyte sedimentation rate, and decreased complement level may support the diagnosis, however a final diagnosis is only established with a tissue biopsy of the involved skin, muscle, and kidney demonstrating the cholesterol crystals.

Q3: What is the treatment and prognosis?

There is no cure for the disease and the treatment is mainly supportive. The prognosis of the condition is poor with a mortality rate of 72%-80%.

Discussion

Cholesterol crystal embolisation, is a...