Abstract

Lubricious polymer-coated intravascular devices have been increasingly used since the mid-1980s. It has since been recognized that the polymer coating may separate from the device and enter the bloodstream. These coatings have been known to embolize to the skin and other vital organs, leading to a wide variety of adverse effects including death. These emboli can be easily missed on routine tissue examination. Cutaneous manifestations typically include non-healing ulcers or purpura and are usually asymptomatic. Supportive care is typically recommended as the material is thought to gradually degrade over a period of weeks to months. We present the case of an 82-year-old male with a three-year history of a non-healing solitary erosion over the right thenar eminence. The lesion was stable in size and character and was asymptomatic other than occasional itching or burning when rubbed. History was significant for catheterization via the right wrist for cardiac angiogram and stent placement three years prior. Shave biopsy revealed slight spongiosis with focal hyperkeratosis and scattered foci of serpiginous clear gray to basophilic stippled material adjacent to dermal blood vessels. Literature review revealed a case of persistently enhancing brain lesions from granuloma formed around polymer emboli after four years and a second case where emboli were identified in an explanted heart after eight years. However, to our knowledge this is the first reported case of a long-standing polymer emboli cutaneous reaction. Our case highlights the importance of increased recognition of polymer emboli, even years after catheterization.

Financial Disclosure:
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