• Rev Med Interne · Apr 2020

    Case Reports

    [Cholesterol crystal embolism mimicking a DRESS].

    • M Dumas, R Flipo, L Blum, C Jouzel, I Brochériou, and E Begon.
    • Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France. Electronic address: dumasmar@gmail.com.
    • Rev Med Interne. 2020 Apr 1; 41 (4): 275-278.

    IntroductionClinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DRESS).Case ReportA 66 year-old woman presented with erythroderma few months after initiation of allopurinol. Acute renal failure was present with elevation in plasma creatinine concentration (523μmol/L) and hypereosinophilia (HE) (5666/mm3). Finally, the REGISCAR score helped to rule out DRESS diagnostic. Past blood-count tests were analyzed revealing chronic HE present before allopurinol initiation. Renal biopsy identified CCE.ConclusionThis case is the first to report a DRESS like presentation of CCE. Clinical findings are secondary to HE and not to occlusion of cutaneous arteries.Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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