Three weeks after coronary angiography, a 66-year-old man has a creatinine of 3.0 mg/dL (baseline 1.1). Examination shows livedo reticularis over the lower abdomen and dusky blue discoloration of two toes. Total count shows eosinophils at 14 percent, ESR is raised, and complement C3 is mildly reduced. Which is the MOST likely diagnosis?

• A Atheroembolic renal disease ✓
• B Contrast induced acute kidney injury
• C Radiocontrast anaphylaxis with interstitial nephritis
• D Polyarteritis nodosa

Explanation

Cholesterol crystal embolisation after arterial instrumentation presents days to weeks later with livedo reticularis, blue toes, eosinophilia, low complement, and slowly progressive renal failure. Contrast nephropathy peaks within 24 to 48 hours and lacks cutaneous and haematological signs, which excludes option B. Polyarteritis nodosa can cause livedo and eosinophilia but the temporal link to catheterisation and blue toes favours atheroemboli.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.