1
|
Dado DN, Huang B, Foster DV, Nielsen JS, Gurney JM, Morrow BD, Sharma K, Chung KK, Ainsworth CR. Management of calciphylaxis in a burn center: A case series and review of the literature. Burns 2018; 45:241-246. [PMID: 30322738 DOI: 10.1016/j.burns.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
Calciphylaxis is a rare, necrotizing skin disorder usually associated with kidney disease, but also caused by many other systemic illnesses. This disease is associated with mortality rates as high as 80% at 1year. We present the demographic and clinical data of nine patients with calciphylaxis treated at our burn center over a 10year period. We review the literature on the clinical presentation, pathophysiology, diagnosis and treatment of this rare disease. We propose that these patients be treated similar to patients with thermal burn injury; meaning intensive wound care, surgical management, critical care and physical therapy. Burn centers are uniquely capable of caring for these incredibly complex patients due to their experience in managing patients with extensive skin and soft tissue defects, wounds and diseases.
Collapse
Affiliation(s)
- David N Dado
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Benjamin Huang
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Daniel V Foster
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - Jamison S Nielsen
- Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Jennifer M Gurney
- Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Benjamin D Morrow
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Kumar Sharma
- Division of Nephrology, University of Texas Health Sciences Center, San Antonio, TX, United States
| | - Kevin K Chung
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Craig R Ainsworth
- Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
| |
Collapse
|
2
|
Monegal A, Peris P, Alsina M, Colmenero J, Guañabens N. Development of multiorganic calciphylaxis during teriparatide, vitamin D, and calcium treatment. Osteoporos Int 2016; 27:2631-4. [PMID: 27010647 DOI: 10.1007/s00198-016-3571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022]
Abstract
Non-uremic calciphylaxis is a severe rare disorder characterized by ischemic necrosis. Recently, three cases of cutaneous calciphylaxis have been described in the context of teriparatide treatment. We present a 51-year-old woman with alcoholic cirrhosis who developed multiorganic calciphylaxis shortly after starting teriparatide treatment associated with calcium and 25-hydroxyvitamin D supplements for severe osteoporosis. After lengthy care of the infectious complications and treatment with bisphosphonates and sodium thiosulfate progressive improvement was observed over a 3-year period. The time between the initiation of teriparatide and the development of calciphylaxis suggests that this agent may have been the triggering factor of this process. Nevertheless, other non-negligible risk factors for calciphylaxis such as alcoholic liver disease, obesity, and vitamin D treatment must also be considered in this patient. Considering the severity of this extremely rare clinical condition, better knowledge of the risk factors related to calciphylaxis development is mandatory.
Collapse
Affiliation(s)
- A Monegal
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain.
| | - P Peris
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain
| | - M Alsina
- Department Dermatology, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain
| | - J Colmenero
- Department of Hepatology Unit, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain
| | - N Guañabens
- Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain
| |
Collapse
|
4
|
Selk N, Rodby RA. Unexpectedly severe metabolic acidosis associated with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy. Semin Dial 2011; 24:85-8. [PMID: 21338397 DOI: 10.1111/j.1525-139x.2011.00848.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Calcific uremic arteriolopathy, formerly known as calciphylaxis is a devastating condition that primarily affects patients with end-stage renal disease. The lesions can progress to massive ulcerations of the subcutaneous tissue that are associated with a high degree of morbidity and mortality, usually related to sepsis. Although the pathophysiology of this condition is poorly understood, it appears to be related to a derangement in calcium-phosphate metabolism. Thus, treatments have focused on the treatment of hyperparathyroidism albeit with poor results. More recently, sodium thiosulfate (STS) has emerged as a promising therapy following multiple case reports of marked disease regression following its use. As STS is a strong acid, metabolic acidosis has been described following its administration, although relatively mild in degree. We report a case of a patient with calciphylaxis who repeatedly developed a severe anion gap metabolic acidosis following each dose of STS requiring a significant reduction in the dose.
Collapse
Affiliation(s)
- Natalie Selk
- Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
| | | |
Collapse
|
5
|
Volpini K, Kinonen C. Abdominal Catastrophe in a 43-Year-Old Female with End Stage Renal Disease. Semin Dial 2011; 24:79-82. [DOI: 10.1111/j.1525-139x.2010.00813.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|