Hyperbaric oxygen therapy in a case of cholesterol crystal embolization

Cholesterol crystal embolism (CCE) is a multiorgan disease, with a high morbidity and mortality rate. This syndrome may occur spontaneously, but more often is a severe iatrogenic complication of an invasive vascular procedure. It is an increasing and still underdiagnosed disease; in fact, its real incidence is unknown. Skin and kidneys are most frequently involved, but any organ can be affected. Biopsy of the ischemic lesions is essential for diagnosis. There is still no established standard treatment of CCE. We report the case of a 56-year-old man who developed CCE with involvement of skin and kidneys 2 weeks after coronary angioplasty. After a long, unsuccessful treatment with high-dose statins, prednisone, and iloprost, hyperbaric oxygen therapy was effective to improve ischemia of distal extremities and renal function and to relieve pain. This is the first case in which the efficacy of hyperbaric oxygen in CCE was tested.