Cardiology Case Scenario - Make Your Diagnosis

A 68-year-old gentleman is admitted with an Anterior myocardial infarction (MI) and receives thrombolysis, aspirin, atenolol, atorvastatin and lisinopril. His ECG shows good ST segment resolution.

The next day he develops some pain in the legs and a dusky discolouration of the lower limbs. On closer examination there is a diffuse petechial rash over the lower limbs, particularly the feet, but all peripheral pulses are palpable.

Investigations reveal:

Haemoglobin	13.3 g/dl	(12-16)
Platelets	145 ×109/l	(150-400)
White cell count	12.1 ×109/l	(4-11)
Neutrophils	6.5 ×109/l	(1.5-7)
Lymphocytes	3.5 ×109/l	(1.5-4)
Eosinophils	1.2 ×109/l	(0.04-0.4)
IgE antibody	3 kU/l	(<2 br="br">

Which of the following is the most likely cause for his current situation?

1. Polyarteritis Nodosa
2. Aspirin Allergy
3. Periphral Vascular Disease
4. Cholesterol Emboli
5. Post Thrombolysis Allergy

Answer

The  above patient is an arteriopath as suggested by the acute Myocardial Infarction, and one day after thrombolysis he develops a petechial rash in the lower limbs with raised white cell count - marked eosinophilia and raised IgE. This suggests cholesterol embolisation syndrome rather than allergy. 

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