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PubMed · 8161101

[Pseudolymphoma caused by cholesterol embolism].

P Castell·J Friedel·J Siré·D Lambert
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Abstract

We report the case of a 60-year old man who, during four years following surgical repair of an inguinal hernia (with transient antithrombotic therapy), suffered from an atypical inflammatory nodule on the dorsum of the left foot with an erythematous plaque on the first intermetatarsal space, together with an inflammatory plaque on the right fifth finger and hairless plaques on both wrists. An ultimate biopsy of the nodule made it possible to discover, unexpectedly, two shadows of cholesterol crystals in a vascular lumen and inside the cytoplasm of a giant multinucleate cell found on a single histological slice and at the deepest part of the fragment. The inflammatory lesions disappeared under a 250 mg/day aspirin treatment. We emphasize the uncommon clinical and pathological pseudo-lymphomatous features of this case and regard our description as original in view of the chronicity of the embolising process.

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AspirinDiagnosis, DifferentialEmbolism, CholesterolFoot DermatosesHumansLymphomaMaleMiddle AgedSkin NeoplasmsCase ReportsEnglish AbstractJournal Article

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P Castell, J Friedel, J Siré, D Lambert. 1993. [Pseudolymphoma caused by cholesterol embolism].. https://pubmed.ncbi.nlm.nih.gov/8161101/

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PubMed2007

Rapid desensitization protocols for patients with cardiovascular disease and aspirin hypersensitivity in an era of dual antiplatelet therapy.

OBJECTIVE: To review the available protocols for rapid desensitization of patients with aspirin hypersensitivity and apply the data for use in patients with cardiovascular disease who would benefit from the dual antiplatelet therapy. DATA SOURCES: A literature search was conducted via MEDLINE from 1966 to December 2006. Main search terms included: aspirin sensitivity, aspirin allergy, aspirin desensitization, aspirin-induced asthma, aspirin therapy, and aspirin intolerance syndrome. STUDY SELECTION AND DATA EXTRACTION: Articles describing rapid aspirin desensitization protocols were selected for review. Literature pertaining to aspirin hypersensitivity, drug desensitization, and the use of aspirin and dual antiplatelet therapy was also examined. Three rapid desensitization protocols were identified and evaluated. DATA SYNTHESIS: While landmark studies demonstrated that dual antiplatelet therapy with aspirin and clopidogrel significantly reduces mortality and morbidity in acute coronary syndromes and coronary stenting, patients with aspirin hypersensitivity are frequently managed with clopidogrel alone with no supporting data. Approximately 10% of the population experiences hypersensitivity to aspirin, which can manifest as asthma exacerbations, rhinorrhea, angioedema, urticaria, and anaphylaxis. The hypersensitivity reaction is mediated through aspirin-directed antibodies or by excessive leukotriene production. The desensitization process involved depletion of these mediators, as well as down-regulation of leukotriene receptors. Two groups of investigators developed rapid protocols to desensitize patients with aspirin hypersensitivity safely and effectively. The rapid protocol developed by Wong provides benefits over other protocols with its low starting dose and completion in less than 3 hours, low incidence of adverse effects, and high success rate in aspirin desensitization. CONCLUSIONS: The Wong protocol is an attractive option for the rapid desensitization of patients requiring dual antiplatelet therapy with aspirin and clopidogrel in the perimyocardial infarction period.

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