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Naranjo A, Rayess N, Ryan E, Iv M, Mahajan VB. Retinal artery and vein occlusion in calciphylaxis. Am J Ophthalmol Case Rep 2022; 26:101433. [PMID: 35372715 PMCID: PMC8968009 DOI: 10.1016/j.ajoc.2022.101433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To report a case of branch retinal artery occlusion (BRAO) followed by branch retinal vein occlusion (BRVO) and paracentral acute middle maculopathy (PAMM) in a patient with confirmed calciphylaxis. Observations A 52-year-old female with a history of BRAO in the right eye one-year prior presented with decreased vision and a new inferotemporal scotoma. Computed tomography angiography of the head and neck demonstrated vascular calcifications at the origin of both ophthalmic arteries, which were otherwise poorly visualized. Ophthalmic examination demonstrated retinal whitening superiorly with intraretinal hemorrhages inferiorly. Optical coherence tomography (OCT) demonstrated middle retinal hyperreflectivity and a mild epiretinal membrane. Fluorescein angiography (FFA) demonstrated delayed perfusion of superior retinal arcade. On further questioning, patient was found to have a history of IgA nephropathy with end-stage renal disease, secondary hyperparathyroidism and calciphylaxis. Calciphylaxis is a systemic disease, characterized by high levels of calcium and progressive calcification of the vascular medial layer leading to ischemia. Anterior ischemic optic neuropathy (AION) and crystalline retinopathy have been reported as ocular manifestations of calciphylaxis, however, there are very few reports on ophthalmic manifestations of calciphylaxis. Conclusion and importance Clinical manifestations of calciphylaxis are variable and a detailed clinical history is important to suspect calciphylaxis. Calciphylaxis should be considered in the differential diagnosis of BRAO, BRVO, PAMM or any ophthalmic vascular manifestation in patients with end-stage renal disease.
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Affiliation(s)
- Andrea Naranjo
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Nadim Rayess
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Emily Ryan
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Michael Iv
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Vinit B. Mahajan
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Molecular Surgery Laboratory, Stanford University, Palo Alto, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Corresponding author. Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, 94304, USA.
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Baby D, Upadhyay M, Joseph MD, Asopa SJ, Choudhury BK, Rajguru JP, Gupta S. Calciphylaxis and its diagnosis: A review. J Family Med Prim Care 2019; 8:2763-2767. [PMID: 31681640 PMCID: PMC6820424 DOI: 10.4103/jfmpc.jfmpc_588_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
Calciphylaxis also known as Calcific uremic arteriolopathy (CUA), is a rare fatal complication usually associated with end-stage renal disease (ESRD). It is characterized by skin ulceration and necrosis leading to significant pain. The disease calciphylaxis is pathological state resulting in accumulation of calcium content in medial wall of small blood vessels along with the fibrotic changes in intima. The aetiopathogenesis of this disease, small vessel vasculopathy, remains complicated, and unclear. It is believed that development of calciphylaxis depends on medial calcification, intimal fibrosis of arterioles and thrombotic occlusion. The disease is rare, life-threatening medical condition that occurs mostly in population with kidney disease or in patients on dialysis. Skin biopsy and radiographic features are helpful in the diagnosis of calciphylaxis, but negative results do not necessarily exclude the diagnosis. This article highlights steps undertaking in the diagnosis of calciphylaxis.
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Affiliation(s)
- Deepak Baby
- Department of Conservative Dentistry and Endodontics, P.S.M Dental College and Research Centre, Akkikavu, Thrissur, Kerala, India
| | - Meenakshi Upadhyay
- Department of Pediatric and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - M. Derick Joseph
- Department of Conservative Dentistry and Endodontics, P.S.M Dental College and Research Centre, Akkikavu, Thrissur, Kerala, India
| | - Swati Joshi Asopa
- Department of Prosthodontics, Rajasthan Dental College and Hospital, Jaipur, Rajasthan, India
| | - Basanta Kumar Choudhury
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Jagadish Prasad Rajguru
- Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Shivangi Gupta
- Department of Periodontics, Private Practitioner, Chandigarh, India
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Calciphylaxis: Successful Management of a Rare Complication of Chronic Kidney Disease in Two Patients. Case Rep Nephrol 2019; 2019:1630613. [PMID: 31316845 PMCID: PMC6601500 DOI: 10.1155/2019/1630613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/02/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
Calciphylaxis, or calcification uremic arteriolopathy, is a rare disease thought to occur due to arteriolar calcifications of the dermis and is responsible for ischemia with cutaneous necrosis and painful panniculitis. Its mechanism remains poorly understood which makes its management challenging and difficult to standardize. We report our management of two patients diagnosed with calciphylaxis. In one patient, calciphylaxis was mentioned upon admission given the context of preexisting secondary hyperparathyroidism and the existence of multiple risk factors. In both patients, the diagnosis was confirmed histologically. Our two observations highlight the difficulty of the diagnosis and the complexity of the therapeutic management that has been personalized according to patient characteristics and clinical evolution. Several therapeutic means can be implemented once the diagnosis is made; nevertheless, its prognosis remains pejorative despite the therapeutic advances. Broad debridement, good phosphocalcic balance control, and the correction of the risk factors top the list of any therapeutic strategy. One of the major challenges of the therapy is normalizing the calcium-phosphate balance. Thus, Cinacalcet and sodium thiosulfate appear to be promising treatments.
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Carter A, Ortega-Loayza AG, Barrett J, Nunley J. Calciphylaxis with evidence of hypercoagulability successfully treated with unfractionated heparin: a multidisciplinary approach. Clin Exp Dermatol 2015; 41:275-8. [PMID: 26290127 DOI: 10.1111/ced.12729] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 02/05/2023]
Abstract
Calciphylaxis is characterized by abnormal calcification of vessels and skin; however, its aetiology and pathogenesis remain unclear. Entities frequently associated with calciphylaxis are end-stage renal disease, diabetes mellitus, hypercalcaemia, hyperphosphataemia, elevated calcium-phosphate product, hyperparathyroidism and possible hypercoagulable states. Skin lesions may remain quiescent or may develop suddenly and progress rapidly. They are more common on the legs. Treatment of calciphylaxis is very challenging and requires interdisciplinary management. We present a case that highlights the difficulty of treating calciphylaxis. A multidisciplinary approach was vital for the proper treatment of our patient. This case also demonstrates the importance of searching for underlying hypercoagulable states, especially in recalcitrant cases. In cases of calciphylaxis with vessel occlusion from microthrombi, heparin therapy would be a logical next step. The effect of anticoagulation may be rapid and impressive.
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Affiliation(s)
- A Carter
- Department of Dermatology, New York Medical College, New York, NY, USA
| | - A G Ortega-Loayza
- Department of Dermatology, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - J Barrett
- Department of Internal Medicine, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - J Nunley
- Department of Dermatology, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA
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Bennis Y, Becquart C, Aljudaibi N, Patenotre P, Guerreschi P, Delaporte E, Duquennoy-Martinot V. [Massive panniculectomy and bilateral subtotal mastectomy in a case of calciphylaxis: A case report and up date]. ANN CHIR PLAST ESTH 2015; 60:527-32. [PMID: 25799428 DOI: 10.1016/j.anplas.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/18/2015] [Indexed: 12/17/2022]
Abstract
Calciphylaxis or calcific arteriolopathy is a rare, life-threatening obstructive pathology of the small cutaneous and subcutaneous vessels. It mainly affects patients with chronic renal failure but it also has been described in patients with normal renal function. The principal risks factors apart from renal failure and phosphocalcic metabolism imbalance are: the female sex, obesity, peripheral vascular disease, diabetes and oral anti-coagulation. We present a very rare case of abdominal, mammarian and upper thighs calciphylaxis in a patient with normal renal function. She presented a severe obesity with a recent important loss of weight and had been treated by oral anticoagulants for a long time. She benefited of a multidisciplinary approach with dermatologists, plastic surgeons and anesthesists permitting a recovery in fourteen weeks. Multidisciplinary approach is necessary but the place of the surgery is not well defined. We report a case in which early and wide surgical approach permitted to obtain a favourable evolution of the pathology. Then, we propose a therapeutic strategy after review of the literature.
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Affiliation(s)
- Y Bennis
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Roger-Salengro, CHRU, 59037 Lille, France.
| | - C Becquart
- Clinique dermatologique, hôpital Claude-Huriez, CHRU, 59037 Lille, France; Faculté de médecine Henri Warembourg, université de Lille, 59045 Lille, France
| | - N Aljudaibi
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Roger-Salengro, CHRU, 59037 Lille, France
| | - P Patenotre
- Chirurgie générale et vasculaire, hôpital Claude-Huriez, CHRU, 59037 Lille, France; Faculté de médecine Henri Warembourg, université de Lille, 59045 Lille, France
| | - P Guerreschi
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Roger-Salengro, CHRU, 59037 Lille, France; Faculté de médecine Henri Warembourg, université de Lille, 59045 Lille, France
| | - E Delaporte
- Clinique dermatologique, hôpital Claude-Huriez, CHRU, 59037 Lille, France; Faculté de médecine Henri Warembourg, université de Lille, 59045 Lille, France
| | - V Duquennoy-Martinot
- Service de chirurgie plastique reconstructrice et esthétique, hôpital Roger-Salengro, CHRU, 59037 Lille, France; Faculté de médecine Henri Warembourg, université de Lille, 59045 Lille, France
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Ferrando F, Ricart J, Vayá A, Mira Y. Actitud ante un paciente con calcifilaxia que precisa anticoagulación. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98:721-2. [DOI: 10.1016/s0001-7310(07)70171-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Management of a Patient With Calciphylaxis and Requiring Anticoagulant Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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