60 year old man came to OPD with complaint of pain over his toes. Earlier , due to acute STEMI, coronary stenting was performed. On local examination of feet , coloured skin lesions were observed with tenderness(As shown below). Gradual fall in renal functions were also seen . What should be the most probable diagnosis?

**Core Concept**
The question is testing the diagnosis of a condition that involves skin lesions, pain, and renal dysfunction in a patient with a history of coronary stenting following an acute ST-elevation myocardial infarction (STEMI).

**Why the Correct Answer is Right**
The combination of skin lesions, pain, and renal dysfunction in a patient with a history of coronary stenting suggests the possibility of cholesterol embolism syndrome (CES). CES occurs when cholesterol crystals from atherosclerotic plaques in the aorta are dislodged and embolize to smaller arteries, causing damage to the endothelial lining and leading to inflammation, thrombosis, and tissue ischemia. The skin lesions observed in the feet are likely due to cholesterol crystals lodging in the small arteries of the skin, causing inflammation and damage. The gradual fall in renal function is also consistent with CES, as the embolized cholesterol crystals can cause damage to the renal microvasculature.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not take into account the patient's history of coronary stenting and the presence of skin lesions. Acute kidney injury (AKI) can occur in various settings, but the combination of skin lesions and renal dysfunction in this patient points towards a more specific diagnosis like CES.
**Option B:** This option is incorrect because it does not consider the patient's history of coronary stenting and the presence of skin lesions. While vasculitis can cause skin lesions and renal dysfunction, it is not the most likely diagnosis in this scenario.

**Clinical Pearl / High-Yield Fact**
Cholesterol embolism syndrome is a potential complication of vascular procedures, including coronary stenting. It is essential to be aware of this condition, especially in patients with a history of atherosclerotic disease, as it can lead to significant morbidity and mortality if not recognized and managed promptly.

**Correct Answer:** C. Cholesterol embolism syndrome.

✓ Correct Answer: D. Atheroembolism