{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:05:44Z","timestamp":1756512344182,"version":"3.44.0"},"reference-count":10,"publisher":"SMC Media","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Cholesterol embolization syndrome (CES) is an atherosclerotic complication affecting different systems with various clinical manifestations, usually triggered iatrogenically by interventional and surgical procedures or thrombolytic therapy, although spontaneous cases have been reported. The hepatobiliary system can also be affected when the showered cholesterol crystals obliterate small vessels within this system causing both ischaemic and inflammatory responses. We describe a case of a male patient who initially developed multiple lacunar cerebral infarcts 10 days post-thrombolytic therapy and percutaneous coronary intervention (PCI) due to acute myocardial infarction. Several weeks later he developed acalculous cholecystitis complicated by liver abscess and kidney injury. The consequences and latency of manifestations within different organs and the temporal relationship with well-known trigger factors raised the suspicion of CES.<\/jats:p>","DOI":"10.12890\/2020_001953","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T09:52:37Z","timestamp":1621936357000},"source":"Crossref","is-referenced-by-count":0,"title":["Acalculous Cholecystitis Complicated by Liver Abscess as a Manifestation of Cholesterol Embolization Syndrome \u2013 Infrequent Manifestation Precipitated by a Common Procedure"],"prefix":"10.12890","volume":"7","author":[{"given":"Ossama","family":"Maadarani","sequence":"additional","affiliation":[{"name":"Internal Medical Department, Ahmadi Hospital \u2013 Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hany","family":"Alfayed","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zouheir","family":"Bitar","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moataz","family":"Daher","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer","family":"Zaalouk","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Abdelfatah","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2020,10,2]]},"reference":[{"key":"10.12890\/2020_001953_ref1","doi-asserted-by":"crossref","unstructured":"<li> Kronzon I, Saric M. Cholesterol embolization syndrome. <em>Circulation<\/em> 2010;<strong>122<\/strong>:631\u2013641. <\/li>","DOI":"10.1161\/CIRCULATIONAHA.109.886465"},{"key":"10.12890\/2020_001953_ref2","doi-asserted-by":"crossref","unstructured":"<li> Quinones A, Saric M. The cholesterol emboli syndrome in atherosclerosis. <em>Curr Atheroscler Rep<\/em> 2013;<strong>15<\/strong>(4):315. <\/li>","DOI":"10.1007\/s11883-013-0315-y"},{"key":"10.12890\/2020_001953_ref3","doi-asserted-by":"crossref","unstructured":"<li> Moolenaar W, Lamers CB. Cholesterol crystal embolization in the Netherlands. <em>Arch Intern Med<\/em> 1996;<strong>156<\/strong>:653\u2013657. <\/li>","DOI":"10.1001\/archinte.1996.00440060081009"},{"key":"10.12890\/2020_001953_ref4","doi-asserted-by":"crossref","unstructured":"<li> Scolari F, Ravani P, Pola A, Guerini S, Zubani R, Movilli E, et al. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. <em>J Am Soc Nephrol<\/em> 2003;14:1584\u20131590.<\/li>","DOI":"10.1097\/01.ASN.0000069220.60954.F1"},{"key":"10.12890\/2020_001953_ref5","doi-asserted-by":"crossref","unstructured":"<li> Hitti WA, Wali RK, Weinman EJ, Drachenberg C, Briglia A. Cholesterol embolization syndrome induced by thrombolytic therapy. Am J Cardiovasc Drugs 2008;8(1):27\u201334. <\/li>","DOI":"10.2165\/00129784-200808010-00004"},{"key":"10.12890\/2020_001953_ref6","doi-asserted-by":"crossref","unstructured":"<li> Ezzeddine MA, Primavera JM, Rosand J, Hedley-Whyte ET, Rordorf G. Clinical characteristics of pathologically proved cholesterol emboli to the brain. Neurology 2000;54:1681\u20131683. <\/li>","DOI":"10.1212\/WNL.54.8.1681"},{"key":"10.12890\/2020_001953_ref7","doi-asserted-by":"crossref","unstructured":"<li> Moolenaar W, Lamers CB. Gastrointestinal blood loss due to cholesterol crystal embolization. <em>J Clin Gastroenterol<\/em> 1995;<strong>21<\/strong>(3):220. <\/li>","DOI":"10.1097\/00004836-199510000-00011"},{"key":"10.12890\/2020_001953_ref8","doi-asserted-by":"crossref","unstructured":"<li> Fine MJ, Kapoor W, Falanga V. Cholesterol crystal embolization: a review of 221 cases in the English literature. <em>Angiology<\/em> 1987;<strong>38<\/strong>:769\u2013784.<\/li>","DOI":"10.1177\/000331978703801007"},{"key":"10.12890\/2020_001953_ref9","doi-asserted-by":"crossref","unstructured":"<li> Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al.; AHA\/ACC, National Heart, Lung, and Blood Institute. 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Potential therapeutic effect of simvastatin on progressive renal failure and nephrotic-range proteinuria caused by renal cholesterol embolism. <em>Am J Med Sci<\/em> 2001;<strong>322<\/strong>:50\u201352. <\/li>","DOI":"10.1097\/00000441-200107000-00010"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/1953\/2366","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/1953\/2367","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/1953\/2367","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T12:17:34Z","timestamp":1756469854000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/1953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,2]]},"references-count":10,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.12890\/2020_001953","relation":{"has-manifestation":[{"id-type":"other","id":"1-65-1953-g2366","asserted-by":"subject"},{"id-type":"other","id":"1-65-1953-g2367","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-65","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"type":"electronic","value":"2284-2594"}],"subject":[],"published":{"date-parts":[[2020,10,2]]},"article-number":"41"}}