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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 198-199

Tendon xanthomas in familial hypercholesterolaemia


Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Gopinath Bharath
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2313_19

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How to cite this article:
Bharath G, Aggarwal P. Tendon xanthomas in familial hypercholesterolaemia. Indian J Med Res 2020;152, Suppl S1:198-9

How to cite this URL:
Bharath G, Aggarwal P. Tendon xanthomas in familial hypercholesterolaemia. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:198-9. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/198/316821

Patient's consent obtained to publish clinical information and images.


A 24 yr old male presented to the department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India, in January 2019, with complaints of typical anginal chest pain and dyspnoea for two days. He was a known case of familial hypercholesterolaemia and had undergone coronary artery bypass grafting in 2002. He also underwent aortic valve replacement for supra-valvular aortic stenosis in 2013. On examination, the patient had bilateral xanthelasma [Figure 1] and multiple tendon xanthomas [Figure 2], [Figure 3], [Figure 4]. Cardiovascular examination revealed metallic click. Electrocardiogram revealed ST depression with T wave inversion in the lead I, II, aVF, V3 to V6. Initial troponin was 0.88 μg/l and repeated troponin was 0.95 μg/l. Percutaneous coronary intervention was done to the radial graft, which had significant osteoproximal disease. He was detected to have PCSK9 (Proprotein convertase subtilisin- like/kexin type 9) mutation. He was advised PCSK9 inhibitor but did not consent. He was discharged on atorvastatin and ezetimibe.
Figure 1: Bilateral xanthelasma.

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Figure 2: Xanthomas over both elbow joints (anteroposterior view).

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Figure 3: Xanthomas over the left elbow joint (lateral view).

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Figure 4: Bilateral extensor tendon xanthomas of the hand.

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This case highlights the importance of clinical examination to provide early clue to underlying aetiology of a premature coronary event.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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