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Cholesterol emboli mimicking acute bacterial endocarditis.

D isseminated cholesterol crystal embolism (CCE) is a complication after manipulation of the aorta or other large arteries during arteriography, angioplasty, or surgical intervention. CCE can also occur spontaneously or after treatment with warfarin, heparin, or thrombolytic agents. In the latter setting, anticoagulation may interfere with the healing of ulcerated atheromatous plaques. The incidence of fever after diagnostic cardiac catheterization is distinctly low. Fever may be associated with pyrogenic reactions resulting from local vascular complications, including phlebitis, hematoma, thromboembolism, local cellulitis, septic complications, or post-infarct pericarditis. We report a patient who had unexplained fever, renal insufficiency, and livedo reticularis of the legs after retrograde coronary angiography. It was thought to be a result of acute bacterial endocarditis (ABE) but was subsequently shown to result from CCE.