A 44-year-old male with smoking habits, irregularly treated hypercholesterolemia with diet and hypocholesterolemia, and chronic ischemic heart disease (with diaphragmatic myocardial infarction in 1985).
She was admitted for angiographic study due to an episode of angina pectoris, both at work and at rest, in the last year despite the use of analgesics B-blockers, nitrates and other drugs prescribed at home.
He returned to the service 24 hours later due to multiple erythematous lesions on the skin of the lower half of the abdomen and lower extremities.
She's admitted for study.
Physical location: Male, 44 years old, normalline; affliction; good color of skin and mucous membranes; bilateral xanthelasma.
PA:105/65.
PCA: Central frequency to 62 ppm.
Abdomen: Blando, painless to palpation without visceromegaly or masses.
Extremities edema, with mass without painful twins due to compression.
Femoral neck, posterior tibial bone and pedal were palpable and symetic.
At the skin level (in the lower half of the abdomen and lower extremities) erythematous lesions consistent with livedo reticularis were observed, and purple coloration of the toes with normal local temperature was observed.
Complementary tests.
Blood count: Leukocytes 10800 (Seg 43%, L 36%, M epithelium, 13%) Hgb: 13.9 g/dl, Hct: 42.7%, Platelets 203.
VSG: 16.
Biochemistry: Glu 129 mg/dl, Urea 30 mg/dl, Cre 1.1 mg/dl, Na 138 mEq/l, K 4.4 mEq/l, GOT 25, GPT 31, CK 20, LDH 331.
Hemostasis: Quick 100%, fibrinogen 335.
Urine: 25 leucocytes/field.
PTG: Total Prot 6.3 g/l, Alb 64%, Alfa 1-G 3.5%, Alfa 2-G 9.8%, Beta-G 11.2%, Gamma-G 12.8%.
Supplement: C3 111 (83-177 mg/dl), C4 27(15-45).
Detection of anti-tissue:
Immunosuppressive complexes: Positive for Ig M. Chest/abdomen radiography: No findings.
Iliac Doppler ultrasound lower limbs: permeable femoral, popliteal veins with no signs of thrombosis and normal flow.
ECG: RS at 62 ppm, BCRDHH, residual lower face necrosis.
Location: Normal.
EMG (performed at 21 days): An irritative root lesion in mild right S1 evolution was observed.
A skin biopsy of the lateral aspect of the right foot revealed the presence of small arterioles of the middle and deep dermis of crystalline enclaved cholesterol phagocyte in part with the presence of occasional giant cells.
The evolution of the patient was satisfactory, with no involvement of the renal function and disappearance of livedo reticularis and persistence of the pigmented epithelium of the fingers.
Symptomatic treatment (with analgesia and its treatment of ischemic heart disease) was followed and she was discharged following her evolution in external consultations.
