Renal failure associated with blue toe syndrome: effective treatment with intravenous prostaglandin E-1.

Sir, Blue toe syndrome is caused by any one of several disorders, including cardiac embolism, hyperviscosity syndrome, hypercoagulable states, and vasculitis. Cholesterol crystal embolism (CCE) is known to be another major cause of this syndrome, which is associated with pain and a bluish discolouration of the toes (1). Its course is limited to the lower limbs and appears relatively benign, but a disseminated cholesterol embolism is a life-threatening condition (2). Renal failure is the most common fatal complication of CCE. We report here a case of blue toe syndrome associated with a CCE together with severe renal dysfunction, which was successfully treated with prostaglandin E-1 (PGE-1).