1
|
Jones E, Valiga A, Solowey M. Distinguishing dystrophic calcification from calciphylaxis. JAAD Case Rep 2023; 40:19-22. [PMID: 37675067 PMCID: PMC10477728 DOI: 10.1016/j.jdcr.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Elizabeth Jones
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander Valiga
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Miriam Solowey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Colboc H, Moguelet P, Bazin D, Letavernier E, Sun C, Chessel A, Carvalho P, Lok C, Dillies AS, Chaby G, Maillard H, Kottler D, Goujon E, Jurus C, Panaye M, Tang E, Courville P, Boury A, Monfort JB, Chasset F, Senet P, Schanne-Klein MC. Elastic fiber alterations and calcifications in calcific uremic arteriolopathy. Sci Rep 2023; 13:15519. [PMID: 37726292 PMCID: PMC10509184 DOI: 10.1038/s41598-023-42492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Calcific uremic arteriolopathy (CUA) is a severely morbid disease, affecting mostly dialyzed end-stage renal disease (ESRD) patients, associated with calcium deposits in the skin. Calcifications have been identified in ESRD patients without CUA, indicating that their presence is not specific to the disease. The objective of this retrospective multicenter study was to compare elastic fiber structure and skin calcifications in ESRD patients with CUA to those without CUA using innovative structural techniques. Fourteen ESRD patients with CUA were compared to 12 ESRD patients without CUA. Analyses of elastic fiber structure and skin calcifications using multiphoton microscopy followed by machine-learning analysis and field-emission scanning electron microscopy coupled with energy dispersive X-ray were performed. Elastic fibers specifically appeared fragmented in CUA. Quantitative analyses of multiphoton images showed that they were significantly straighter in ESRD patients with CUA than without CUA. Interstitial and vascular calcifications were observed in both groups of ESRD patients, but vascular calcifications specifically appeared massive and circumferential in CUA. Unlike interstitial calcifications, massive circumferential vascular calcifications and elastic fibers straightening appeared specific to CUA. The origins of such specific elastic fiber's alteration are still to be explored and may involve relationships with ischemic vascular or inflammatory processes.
Collapse
Affiliation(s)
- Hester Colboc
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, UMRS_1155, 5, Rue Santerre, 75012, Paris, France.
| | - Philippe Moguelet
- Sorbonne Université, Hôpital Tenon, Anatomie et Cytologie Pathologiques, Paris, France
| | - Dominique Bazin
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, 91405, Orsay, France
| | - Emmanuel Letavernier
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, UMRS_1155, Paris, France
| | - Chenyu Sun
- Laboratoire d'Optique et Biosciences, CNRS, Inserm, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Anatole Chessel
- Laboratoire d'Optique et Biosciences, CNRS, Inserm, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| | - Priscille Carvalho
- Centre Hospitalier Universitaire de Rouen, Service de Dermatologie, Rouen, France
| | - Catherine Lok
- Centre Hospitalier Universitaire d'Amiens, Service de Dermatologie, Amiens, France
| | | | - Guillaume Chaby
- Centre Hospitalier Universitaire d'Amiens, Service de Dermatologie, Amiens, France
| | - Hervé Maillard
- Centre Hospitalier du Mans, Service de Dermatologie, Le Mans, France
| | - Diane Kottler
- Centre Hospitalier Universitaire de Caen, Service de Dermatologie, Caen, France
| | - Elisa Goujon
- Centre Hospitalier de Chalon-sur-Saône, Service de Dermatologie, Chalon, France
| | - Christine Jurus
- Clinique du Tonkin, Service de Médecine Vasculaire, Villeurbanne, France
| | - Marine Panaye
- Clinique du Tonkin, Service de Médecine Vasculaire, Villeurbanne, France
| | - Ellie Tang
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, UMRS_1155, Paris, France
| | - Philippe Courville
- Centre Hospitalier Universitaire de Rouen, Anatomie et Cytologie Pathologiques, Rouen, France
| | - Antoine Boury
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, 91405, Orsay, France
| | - Jean-Benoit Monfort
- Sorbonne Université, Faculté de Médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, Service de Dermatologie 3t Allergologie, Hôpital Tenon, INSERM U1135, CIMI, Paris, France
| | - Patricia Senet
- Sorbonne Université, Faculté de Médecine, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Marie-Claire Schanne-Klein
- Laboratoire d'Optique et Biosciences, CNRS, Inserm, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
| |
Collapse
|
3
|
Xia J, Tan AJ, Biglione B, Cucka B, Ko L, Nguyen ED, Khoury CC, Robinson MK, Nigwekar SU, Kroshinsky D. Nephrogenic Calciphylaxis Arising after Bariatric Surgery: A Case Series. Am J Nephrol 2023; 55:196-201. [PMID: 37487472 DOI: 10.1159/000531784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
Nephrogenic calciphylaxis is associated with multiple risk factors including long-term dialysis dependence, hyperphosphatemia, hypercalcemia, parathyroid hormone derangements, vitamin K deficiency, obesity, diabetes mellitus, warfarin use, and female sex. Bariatric surgery is known to cause altered absorption, leading to mineral and hormonal abnormalities in addition to nutritional deficiency. Prior case reports on calciphylaxis development following bariatric surgery have been published, though are limited in number. We report a case series of five bariatric patients from a single institution who developed nephrogenic calciphylaxis between 2012 and 2018. These patients had a history of bariatric surgery, and at the time of calciphylaxis diagnosis, demonstrated laboratory abnormalities associated with surgery including hypercalcemia (n = 3), hyperparathyroidism (n = 2), hypoalbuminemia (n = 5), and vitamin D deficiency (n = 5), in addition to other medication exposures such as vitamin D supplementation (n = 2), calcium supplementation (n = 4), warfarin (n = 2), and intravenous iron (n = 1). Despite the multifactorial etiology of calciphylaxis and the many risk factors present in the subjects of this case series, we submit that bariatric surgery represents an additional potential risk factor for calciphylaxis directly stemming from the adverse impact of malabsorption and overuse of therapeutic supplementation. We draw attention to this phenomenon to encourage early consideration of calciphylaxis in the differential for painful skin lesions arising after bariatric surgery as swift intervention is essential for these high-risk patients.
Collapse
Affiliation(s)
- Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA,
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca Biglione
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Cucka
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Ko
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily D Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charbel C Khoury
- Department of Nephrology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Malcolm K Robinson
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sagar U Nigwekar
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Cucka B, Biglione B, Ko L, Nguyen ED, Khoury CC, Nigwekar SU, Robinson MK, Kroshinsky D. Calciphylaxis arising following bariatric surgery: A case series. JAAD Case Rep 2022; 28:4-7. [PMID: 36090194 PMCID: PMC9450058 DOI: 10.1016/j.jdcr.2022.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
5
|
Colboc H, Bettuzzi T, Badrignans M, Bazin D, Boury A, Letavernier E, Frochot V, Tang E, Moguelet P, Ortonne N, de Prost N, Ingen-Housz-Oro S, Daudon M. Relationship between calcinosis cutis in epidermal necrolysis and caspofungin, a physicochemical investigation. CR CHIM 2022. [DOI: 10.5802/crchim.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
6
|
Colboc H, Moguelet P, Letavernier E, Frochot V, Bernaudin JF, Weil R, Rouzière S, Senet P, Bachmeyer C, Laporte N, Lucas I, Descamps V, Amode R, Brunet-Possenti F, Kluger N, Deschamps L, Dubois A, Reguer S, Somogyi A, Medjoubi K, Refregiers M, Daudon M, Bazin D. Pathologies related to abnormal deposits in dermatology: a physico-chemical approach. CR CHIM 2022. [DOI: 10.5802/crchim.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
7
|
Colboc H, Fontaine J, Bazin D, Frochot V, Letavernier E, Daudon M, Laporte N, Rouzière S, Reby M, Galezowski A, Forasassi C, Meaume S. Calcified leg Ulcers in older patients: clinical description, morphology and chemical characterization. J Gerontol A Biol Sci Med Sci 2021; 77:27-32. [PMID: 34331540 DOI: 10.1093/gerona/glab223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Chronic wounds, including leg ulcers, constitute an important medical problem among older patients. Dystrophic calcifications (DC) are associated with a variety of disorders, including leg ulcers. The aim of this study was to report the clinical and biological characteristics of older patients with DC in leg ulcers and to determine the morphology and chemical composition of these calcifications. We conducted a prospective monocentric study in our Geriatric-Wound and Healing ward, Rothschild Hospital, Paris, from January 2018 to December 2019. Patients with leg ulcers were screened for DC by palpation. Patients' clinical, biological and radiological findings were collected. DC morphology was analyzed using field-emission scanning electron microscopy and chemical composition was analyzed using µFourier transform infra-red spectroscopy and X-ray Fluorescence. Ten (7%) of the 143 patients hospitalized for leg ulcers presented DC. Older patients with DC were more likely to have leg ulcers with venous insufficiency (P=0.015), colonized by Pseudomonas aeruginosa (P=0.026), with a longer healing evolution (P=0.0072) and hypercalcemia (P=0.041). Five DC were extracted from ulcers: two presented 500 nm lacunar spheres and intermingled fibrils of about 10 nm in diameter, consistent with bacterial and biofilm imprints. DC were always composed of Calcium-phosphate apatite and associated to the presence of Zinc. Our analyses were consistent with the involvement of microorganisms and inflammatory process in DC formation. Early management of venous insufficiency, treatment of chronic bacterial colonization and use of calcium-solubilizing drugs seem to be rational strategies for calcified leg ulcer management in older patients.
Collapse
Affiliation(s)
- Hester Colboc
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Juliette Fontaine
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | | | - Vincent Frochot
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Emmanuel Letavernier
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Michel Daudon
- Sorbonne Université, Hôpital Tenon, Service des Explorations Fonctionnelles Multidisciplinaires, Paris, France.,UMR_S 1155, Sorbonne Université-UPMC Paris 06, F-75020 Paris, France
| | - Naomi Laporte
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Stéphan Rouzière
- Laboratoire de Physique des Solides, CNRS, Université Paris-Saclay, Orsay, France
| | - Michael Reby
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Agnes Galezowski
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Christine Forasassi
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| | - Sylvie Meaume
- Sorbonne Université, Hôpital Rothschild, Service Plaies et Cicatrisation, Paris, France
| |
Collapse
|
8
|
Mbuyi N, Cunha JS. A Middle-Aged Woman With Necrotic Breast Lesions. Arthritis Care Res (Hoboken) 2019; 73:462-470. [PMID: 31651087 DOI: 10.1002/acr.24099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Nadine Mbuyi
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joanne S Cunha
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
9
|
Abstract
Calciphylaxis is a rare disease that typically presents in patients with end-stage renal disease on dialysis or those who have received a renal transplant. Nonuremic calciphylaxis leads to ischemia and subsequent necrosis of subcutaneous tissue. Diseases associated with nonuremic calciphylaxis include primary hyperparathyroidism, connective tissue disease, malignancy, and alcoholic liver disease. Due to its high mortality, early identification and an aggressive multidisciplinary treatment approach is necessary to improve patient outcomes.
Collapse
|
10
|
Bajaj R, Courbebaisse M, Kroshinsky D, Thadhani RI, Nigwekar SU. Calciphylaxis in Patients With Normal Renal Function: A Case Series and Systematic Review. Mayo Clin Proc 2018; 93:1202-1212. [PMID: 30060958 DOI: 10.1016/j.mayocp.2018.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To define concomitant risk factors, treatment, and outcomes for patients with nonnephrogenic calciphylaxis (NNC). PATIENTS AND METHODS A retrospective review of Massachusetts General Hospital (MGH) medical records (January 1, 2014, through February 29, 2016) and a systematic literature review of PubMed, Google Scholar, EMBASE, MEDLINE, and CENTRAL (August 1, 1970, through July 31, 2016) were performed. Demographic characteristics and concomitant features were summarized and compared between patients with different lesion characteristics. Outcomes (lesion improvement and mortality) and their predictors were analyzed. RESULTS Nine patients (median age, 72 years [interquartile range (IQR), 44-82 years]; 78% women; 89% white race) were identified through MGH records. The literature review identified 107 patients (median age, 60 years [IQR, 49-72 years]; 77% women; 86% white race). Vitamin K antagonism and obesity were the most common concomitant factors. In the literature review, lower age (P<.001) and higher body mass index (P=.03) were associated with the central location of lesions, whereas vitamin K antagonism was associated with the peripheral location (P=.009). In the MGH series, median survival was 24.0 months (95% CI, 7.8-36.0 months), and 33% (95% CI, 14%-60%) had lesion improvement by 6 months. In the literature review, median survival was 4.2 months (95% CI, 1.9-5.9 months), median time to lesion improvement was 5.9 months (95% CI, 3.9-8.9 months), and none of the treatments were associated with lesion improvement or survival. CONCLUSION This description of concomitant traits may augment an earlier recognition of NNC. Future research is needed to investigate NNC pathogenesis and treatments.
Collapse
Affiliation(s)
- Richa Bajaj
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Khorana Scholar 2016, Khorana Program for Scholars, INDO-US Science and Technology Forum, New Delhi, India
| | - Marie Courbebaisse
- Division of Bone and Mineral Research, Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA; Faculty of Medicine, Paris Descartes University, Paris, France
| | | | - Ravi I Thadhani
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Department of Biomedical Sciences and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sagar U Nigwekar
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA.
| |
Collapse
|
11
|
De Flammineis E, Mulvaney PM, Kraft S, Mihm MC, Das S, Kroshinsky D. A 71-Year-Old Female with Myocardial Infarction and Long-Standing Ulcers on the Thigh. Dermatopathology (Basel) 2018; 4:18-23. [PMID: 29456997 PMCID: PMC5803738 DOI: 10.1159/000481727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Calciphylaxis is most commonly encountered in patients with end-stage renal disease; however, it is increasingly observed in nonuremic patients as well. It is important to consider and diagnose nonuremic calciphylaxis early, as prompt treatment and mitigation of associated risk factors is essential to improve long-term outcomes for these patients. Here, we present the case of a 71-year-old woman with atrial fibrillation on warfarin, but without renal disease, who presented with two long-standing ulcers on her thigh and was diagnosed with the aid of biopsy with calciphylaxis. We review the existing literature on the subject and offer this case as a representative report of a clinicopathologic correlation for this disorder.
Collapse
Affiliation(s)
| | - Patrick M Mulvaney
- Harvard Combined Dermatology Residency Program, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kraft
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Martin C Mihm
- Department of Dermatology and Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shinjita Das
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
12
|
Malhi HK, Didan A, Ponosh S, Kumarasinghe SP. Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer. Case Rep Dermatol 2017; 9:95-102. [PMID: 28512404 PMCID: PMC5422727 DOI: 10.1159/000468977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
Martorell ulcer is a form of lower limb ulceration, preceded by a small area of excruciating pain. It often appears as a solitary lesion on the outer aspect of the lower limb, and is primarily associated with poorly controlled hypertension and diabetes. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of blood pressure, management of infection, and wound care. We describe a 77-year-old diabetic and hypertensive woman presenting with excruciating pain in her right lower lateral leg leading to a necrotic ulcer. Serial photographs of the evolution of the lesion and eventual healing of the ulcer are presented.
Collapse
Affiliation(s)
| | - Ali Didan
- bFiona Stanley Hospital, Murdoch, WA, Australia
| | - Stefan Ponosh
- cSir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | |
Collapse
|
13
|
A 56-Year-Old Woman With Multiple Subcutaneous Painful Nodules in the Absence of Renal Disease: Answer. Am J Dermatopathol 2017; 41:71-72. [PMID: 28375858 DOI: 10.1097/dad.0000000000000892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Abstract
Ulceration is a common negative prognostic marker of solid tumors including melanoma. The signaling basis of ulceration is being elucidated. PHIP has been found to be amplified in wild-type melanomas, resulting in Akt activation and aerobic glycolysis (Warburg effect), associated with ulceration. The ulceration phenotype likely represents the genotype of the reactive oxygen driven tumor, in which reactive oxygen drives angiopoietin-2 production, tumor growth, and invasion. This phenotype is amenable to pharmacologic intervention.
Collapse
|
15
|
Malabu UH, Roberts LJ, Sangla KS. Calciphylaxis in a morbidly obese woman with rheumatoid arthritis presenting with severe weight loss and vitamin D deficiency. Endocr Pract 2012; 17:e104-8. [PMID: 21742604 DOI: 10.4158/ep11099.cr] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritis and normal renal function. METHODS We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year. RESULTS The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritis were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight. CONCLUSION This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy.
Collapse
Affiliation(s)
- Usman H Malabu
- Department of Endocrinology and Diabetes, The Townsville Hospital, Douglas, Australia.
| | | | | |
Collapse
|
16
|
Vedvyas C, Winterfield LS, Vleugels RA. Calciphylaxis: a systematic review of existing and emerging therapies. J Am Acad Dermatol 2011; 67:e253-60. [PMID: 21821309 DOI: 10.1016/j.jaad.2011.06.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 05/20/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022]
Abstract
Calciphylaxis, also known as calcific uremic arteriolopathy, is a cutaneous ischemic small vessel vasculopathy seen in 1 to 4% of patients with chronic kidney disease on hemodialysis. It is associated with extreme pain and a 60 to 80% mortality rate in the setting of few and frequently ineffective therapeutic options, although this may be changing based on reports of success with newer therapies.
Collapse
Affiliation(s)
- Chetan Vedvyas
- Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | |
Collapse
|
17
|
Kolli S, Douglas J, Doumit E, Guglin M. Cardiomyopathy and calciphylaxis in a patient with normal renal function: a case report. ACTA ACUST UNITED AC 2010; 16:71-2. [PMID: 20412472 DOI: 10.1111/j.1751-7133.2009.00121.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Swathy Kolli
- University of South Florida, Tampa General Hospital, Tampa, FL 33606, USA
| | | | | | | |
Collapse
|
18
|
Kalisiak M, Courtney M, Lin A, Brassard A. Calcific uremic arteriolopathy (calciphylaxis): successful treatment with sodium thiosulfate in spite of elevated serum phosphate. J Cutan Med Surg 2009; 13 Suppl 1:S29-34. [PMID: 19480749 DOI: 10.2310/7750.2009.00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michal Kalisiak
- Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
| | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Calcific uraemic arteriolopathy (CUA) or calciphylaxis is a rare but important cause of morbidity and mortality in patients with chronic kidney disease. The prevalence of CUA is increasing in patients with renal failure, and the condition is also being recognized in nonuraemic patients. RECENT FINDINGS There has been increasing understanding of the molecular basis of vascular calcification, in particular on the important role of the uraemic microenvironment in the factors implicated in the differentiation of vascular smooth muscle cells into osteoblasts. New options for treatment of hyperphosphataemia and secondary hyperparathyroidism in patients with chronic kidney disease have become available in the last few years and these have begun to be used in patients with CUA. These include bisphosphonates, newer noncalcium/nonaluminium-containing phosphate binders and case reports of use of cinacalcet. Other treatments for CUA that are not targeted directly at calcium/phosphate homeostasis include hyperbaric oxygen and the antioxidant cation chelator sodium thiosulphate. SUMMARY Clinicians managing patients with CUA should consider a combination approach of treating deranged calcium/phosphate with newer therapeutic agents and promoting wound healing with other older modalities such as hyperbaric oxygen and sodium thiosulphate infusions. Randomized controlled trials for treatments in CUA are still lacking.
Collapse
|
20
|
Nigwekar SU, Wolf M, Sterns RH, Hix JK. Calciphylaxis from nonuremic causes: a systematic review. Clin J Am Soc Nephrol 2008; 3:1139-43. [PMID: 18417747 DOI: 10.2215/cjn.00530108] [Citation(s) in RCA: 263] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic information is available on calciphylaxis from nonuremic causes. This systematic review was designed to characterize etiologies, clinical features, laboratory abnormalities, and prognosis of nonuremic calciphylaxis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A systematic review of literature for case reports and case series of nonuremic calciphylaxis was performed. Cases included met the operational definition of nonuremic calciphylaxis-histopathologic diagnosis of calciphylaxis in the absence of end-stage kidney disease, renal transplantation, or acute kidney injury requiring renal replacement therapy. RESULTS We found 36 cases (75% women, 63% Caucasian, aged 15 to 82 yr) of nonuremic calciphylaxis. Primary hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue disease were the most common reported causes. Preceding corticosteroid use was reported for 61% patients. Protein C and S deficiencies were seen in 11% of patients. Skin lesions were morphologically similar to calcific uremic arteriolopathy. Mortality rate was 52%, with sepsis being the leading cause of death. CONCLUSION Calciphylaxis should be considered while evaluating skin lesions in patients with predisposing conditions even in the absence of end-stage kidney disease and renal transplantation. Nonuremic calciphylaxis is reported most often in white women. Mineral abnormalities that are invoked as potential causes in calcific uremic arteriolopathy are often absent, suggesting that heterogeneous mechanisms may contribute to its pathogenesis. Nonuremic calciphylaxis is associated with high mortality, and there is no known effective treatment.
Collapse
Affiliation(s)
- Sagar U Nigwekar
- Departments of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA.
| | | | | | | |
Collapse
|
21
|
|
22
|
de la Cueva-Dobao P, González-Carrascosa M, Mauleón-Fernández C, Silvente-San Nicasio C, Fernández RS, Lázaro-Ochaita P. Calcifilaxia. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0213-9251(05)72296-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|