1
|
Yousuf S, Busch D, Renner R, Schliep S, Erfurt-Berge C. Clinical characteristics and treatment modalities in uremic and non uremic calciphylaxis - a dermatological single-center experience. Ren Fail 2024; 46:2297566. [PMID: 38178572 PMCID: PMC10773653 DOI: 10.1080/0886022x.2023.2297566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
Calciphylaxis (CP) is a serious, potentially life-threatening disease that presents with medial calcification of small-sized vessels and painful ischemic ulcerations. Although calciphylaxis is frequently seen in patients with end-stage kidney disease on dialysis (calcific uremic arteriolopathy, CUA), there are reported cases of nonuremic calciphylaxis (NUC), which often remain undiagnosed. We conducted a retrospective chart review at our dermatological hospital and evaluated data concerning the epidemiology, comorbidities, medication, laboratory abnormalities, and therapeutic approaches of 60 patients diagnosed with calciphylaxis between 01/2012 and 12/2022. We identified 21 patients diagnosed with NUC and 39 with kidney disease. The predilection sites of skin lesions were the lower legs in 88% (n = 53), followed by the thigh and gluteal regions in 7% (n = 4). Significant differences were identified in comorbidities, such as atrial fibrillation (p < 0.001) and hyperparathyroidism (p < 0.01) accounting for CUA patients. Medication with vitamin K antagonists (p < 0.001), phosphate binders (p < 0.001), and loop diuretics (p < 0.01) was found to be associated with the onset of calciphylaxis. Hyperphosphatemia (p < 0.001), increased parathyroid hormone (p < 0.01) and triglyceride levels (p < 0.01), hypoalbuminemia (p < 0.01) and decreased hemoglobin values (p < 0.001) in the CUA cohort were significantly different from those in the NUC group. All patients with CUA received systemic medication. In contrast, only 38% (n = 8) of patients with NUC received systemic treatment. Striking discrepancies in the treatment of both cohorts were detected. In particular, NUC remains a disease pattern that is still poorly understood and differs from CUA in several important parameters.
Collapse
Affiliation(s)
- Sabine Yousuf
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dorothee Busch
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Stefan Schliep
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Cornelia Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Abdalla M, Faris ME, Saad E, Meng Q, Friedman H, Soifer N. Profound metabolic acidosis in association with sodium thiosulfate therapy in a patient with calcific uremic arteriolopathy: a case report and literature review. CEN Case Rep 2024; 13:59-65. [PMID: 37273129 PMCID: PMC10834920 DOI: 10.1007/s13730-023-00801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Calciphylaxis, also known as Calcific uremic arteriolopathy (CUA), is a serious disorder that presents with skin necrosis due to calcification of dermal and subcutaneous adipose tissue capillaries and arterioles. The condition occurs primarily in patients with end-stage renal disease (ESRD) on dialysis, and it carries high morbidity and mortality, primarily due to sepsis, with an estimated six-month survival of approximately 50%. Although there are no high-quality studies to guide the optimal treatment approach for patients with calciphylaxis, many retrospective studies and case series support treatment with sodium thiosulfate (STS). Despite the frequent use of STS as an off-label treatment, data regarding its safety and efficacy are limited. STS has generally been considered a safe drug with mild side effects. However, severe metabolic acidosis associated with STS is a rare and life-threatening complication of STS treatment and is often unpredictable. Herein, we report a 64-year-old female with ESRD on peritoneal dialysis (PD) who presented with a profound high anion gap metabolic acidosis and severe hyperkalemia while on STS treatment for CUA. No other etiology for her severe metabolic acidosis other than STS was identified. ESRD patients receiving STS should be monitored closely for this side effect. Dose reduction, increasing the duration of infusion, or even discontinuing STS treatment should be considered if severe metabolic acidosis develops.
Collapse
Affiliation(s)
- Mohammed Abdalla
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA.
| | - Mohammed Elamin Faris
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Eltaib Saad
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Qingqing Meng
- Medical Residents, Department of Internal Medicine, Ascension Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA
| | - Harvey Friedman
- Pulmonary and Critical Care Attending, Department of Critical Care and Pulmonology, Ascension Saint Francis Hospital, Evanston, IL, USA
| | - Neil Soifer
- Lakeside Nephrology, Ascension Saint Francis Hospital, Evanston, IL, USA
| |
Collapse
|
3
|
Andersen S, Saltvig I, Uth CC. Calciphylaxis with atypical localisation in a woman with end-stage renal disease. Ugeskr Laeger 2024; 186:V08230540. [PMID: 38235723 DOI: 10.61409/v08230540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Calciphylaxis is a rare condition characterised by painful necroses due to microvascular calcifications. It primarily affects individuals with end-stage renal disease and affected calcium-phosphate metabolism. This is a case report of a 55-year-old woman with end-stage renal disease who developed a necrotic ulcer at the breast due to calciphylaxis. Although treated with sodium thiosulfate and hyperbaric oxygen, the ulcer progressed and multiple necrotic calciphylaxis ulcers appeared. The treatment options and wound management are discussed while focusing on indications for surgical debridement.
Collapse
Affiliation(s)
- Sakshi Andersen
- Afdeling for Plastikkirurgi og Brandsårsbehandling, Københavns Universitetshospital - Rigshospitalet
| | - Iselin Saltvig
- Afdeling for Plastikkirurgi og Brandsårsbehandling, Københavns Universitetshospital - Rigshospitalet
| | - Charlotte Caspara Uth
- Afdeling for Plastikkirurgi og Brandsårsbehandling, Københavns Universitetshospital - Rigshospitalet
| |
Collapse
|
4
|
Richardson BB, Stees MA, Gumbiner BR. Nonuremic Calciphylaxis: A Rare and Unexpected Diagnosis of Necrotic Ulcers. J Am Podiatr Med Assoc 2024; 114:21-174. [PMID: 38446547 DOI: 10.7547/21-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Calciphylaxis is a rare and devastating condition found almost exclusively in patients with end-stage renal disease. Nonuremic calciphylaxis, an even more rare diagnosis, occurs in patients with preserved kidney function. We present a fatal case of nonuremic calciphylaxis with delayed and unexpected diagnosis despite early biopsy and testing. The patient presented with a 2-month history of painful ulceration to the left leg. Early biopsy was negative for calciphylaxis. Laboratory tests were negative for renal disease and autoimmune disorders. There was elevated parathyroid hormone (96 pg/mL) 3 months after initial presentation and documented cobalamin deficiency. The patient went on to develop wounds to both legs and her thighs. A second biopsy of a left thigh wound by means of the dermatology service revealed calciphylaxis. The purpose of this case report is to raise awareness of calciphylaxis as a differential diagnosis for chronic necrotic skin ulcers, especially in patients with preserved renal function and those on warfarin therapy.
Collapse
Affiliation(s)
| | - Marc A Stees
- †Community General Hospital Medical Center, Sterling, IL
| | | |
Collapse
|
5
|
Torre AC, Bastard DP, Diehl M, Rosa-Diez G, Volonteri V, Mazzuoccolo LD, Belatti AL. [Calciphylaxis, risk factors, treatment and outcomes. Retrospective study of 39 patients]. Medicina (B Aires) 2024; 84:196-205. [PMID: 38683504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Calciphylaxis is a serious vascular disorder characterized by calcification of tunica media, intimal hyperplasia, thrombosis, and skin necrosis. It was described in patients with renal failure (UC), although it can occur in its absence (NUC). Its risk factors are under study and its diagnosis can be complex. Over a decade ago, its mortality was estimated at 60-80%. Recent studies indicate that it has decreased (40%). METHODS A retrospective study was carried out in the period between January 1, 2011 and December 31, 2019. The past medical record, clinical characteristics, laboratory and histopathological findings, and evolution of all patients with calciphylaxis evaluated at the Hospital Italiano de Buenos Aires were reviewed. RESULTS Thirty-nine patients were included. Sixtyone percent were men and 39% were NUC cases. Eightytwo percent had arterial hypertension, 66% obesity and 46% diabetes. Of those, 49% received coumarin anticoagulants. All patients with NUC and 75% with UC presented ulcers with necrosis, located more frequently on the legs. In 72% of the cases the histological diagnosis was made with one biopsy. In all the treatment was multimodal and mortality at one year was 42%. CONCLUSION We observed a high proportion of patients with NUC, in relation to what is reported in the literature, and that half received vitamin K antagonists. The histological diagnosis was made with one biopsy in most of the cases, as the surgical technique for taking the sample, the Von Kossa staining and the evaluation by an expert pathologist were the key of it.
Collapse
Affiliation(s)
- Ana C Torre
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - Dolores P Bastard
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria Diehl
- Servicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Rosa-Diez
- Servicio de Nefrología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Volonteri
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis D Mazzuoccolo
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anahi L Belatti
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
6
|
Pan Y, Wang H, Ye Y, Lv M, Zhu Y, Wang N, Zhao J, Shi J, Lv X. The application of MDT model for calciphylaxis management in patients with end-stage renal disease. Int Wound J 2023; 20:3717-3723. [PMID: 37309083 PMCID: PMC10588363 DOI: 10.1111/iwj.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023] Open
Abstract
This study focuses on the application of nurse-led multidisciplinary collaborative therapy (MDT) management model for calciphylaxis prevention of patients with terminal renal disease. Through the establishment of a multidisciplinary management team spanning nephrology department, blood purification center, dermatology department, burn and plastic surgery department, infection department, stem cell platform, nutrition department, pain department, cardiology department, hydrotherapy group, dermatology group, and outpatient treatment room, the distribution of duties among team members were clarified to bring out the best advantages of a multidisciplinary teamwork during treatment and nursing. For patients with calciphylaxis symptoms in terminal renal disease, a case-by-case management model was carried out with the focus on personalised problem. We emphasised on personalised wound care, precise medication care, active pain management, psychological intervention and palliative care, the amelioration of calcium and phosphorus metabolism disorder, nutritional supplementation, and the therapeutic intervention based on human amniotic mesenchymal stem cell regeneration. The MDT model effectively compensates for traditional nursing mode and could serve as a novel clinical management modality for calciphylaxis prevention in patients with terminal renal disease.
Collapse
Affiliation(s)
- Yanyan Pan
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hui Wang
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yajun Ye
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Manman Lv
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yamei Zhu
- Blood Purification CenterThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Ningning Wang
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jing Zhao
- Outpatient Treatment RoomThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jingping Shi
- Department of Plastic and BurnThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiaolin Lv
- Department of NephrologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| |
Collapse
|
7
|
Wipattanakitcharoen A, Takkavatakarn K, Susantitaphong P. Risk factors, treatment modalities, and clinical outcomes of penile calciphylaxis: systematic review. World J Urol 2023; 41:2959-2966. [PMID: 37782324 DOI: 10.1007/s00345-023-04611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To perform a systematic review of case reports and case series to investigate risk factors, treatment modalities, and the outcome of penile calciphylaxis. METHOD We performed a systematic search of the MEDLINE and Scopus databases to identify case reports or case series of penile calciphylaxis. The patient characteristics, laboratory investigations, diagnostic modalities, treatment modalities, and outcomes were extracted. We compared clinical characteristics and treatment between patients who survived or demised and between patients with clinical improvement and those without to identify the poor prognostic risk factors. RESULTS Ninety-four articles were included from 86 case reports and 8 case series with 121 patients. Most of the patients were on hemodialysis (78.9%). The median time since starting dialysis was 48 months (24-96 months). Sodium thiosulfate was used to treat penile calciphylaxis in 23.6%. For surgical management, partial or total penectomy was performed in 45.5% of the patients. There was no association between sodium thiosulfate use, partial or total penectomy, and improvement in clinical outcomes. The mortality rate in patients with penile calciphylaxis was 47.8% and the median time to death was 3 months (0.75-9 months). The presence of extragenital involvement was significantly related to mortality (p = 0.03). CONCLUSION A calcified penile artery results in penile calciphylaxis, a rare vascular phenomenon associated with high morbidity and mortality. Management of penile calciphylaxis includes the medical management of risk factors, surgical debridement, or penectomy. Therefore, early prevention and diagnosis as well as immediate appropriate treatment are needed.
Collapse
Affiliation(s)
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Research Unit for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
8
|
Yu Y, Chen Y, Yang F, Song Q. Black necrosis of the glans penis associated with calciphylaxis: A case report. Medicine (Baltimore) 2023; 102:e35609. [PMID: 37861559 PMCID: PMC10589551 DOI: 10.1097/md.0000000000035609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
RATIONALE Calciphylaxis, known as calcific uremic arteriolopathy, is a rare cause of dry gangrene. Despite an increase in the clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high mortality. PATIENT CONCERNS AND DIAGNOSES We present a 45-year-old man, who was diagnosed with calciphylaxis disease, with a history of diabetes mellitus, end-stage renal disease and cirrhosis with a half-month evolution of painful dry gangrene on his glans penis and scrotum. The patient also presented with gangrene of fingers. INTERVENTIONS AND OUTCOMES The patient and his family opted for palliative care. However, he died eventually. LESSONS This case contributed to the current understanding of calciphylaxis. Since no standard treatment is available and the prognosis remained poor, early, and accurate diagnosis of calciphylaxis is important. We here report the current case and provide data for the diagnosis and treatment of this kind of disease.
Collapse
Affiliation(s)
- Youwei Yu
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yangxi Chen
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Fan Yang
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qitai Song
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| |
Collapse
|
9
|
Liang S, Guan M, Liu Z, Ruan X, Huang H, Zhong H. Sailing between scylla and charybdis-anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review. Ren Fail 2023; 45:2264401. [PMID: 37799073 PMCID: PMC10561572 DOI: 10.1080/0886022x.2023.2264401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023] Open
Abstract
Calciphylaxis is a rare and life-threatening condition in patients with end-stage kidney disease (ESKD). In this case report, we reported a 72-year-old female who had undergone aortic and mitral mechanical valve replacement 22 years ago due to rheumatic aortic and mitral stenosis. Following the valve replacement, she initiated warfarin treatment. Five years ago, she received a diagnosis of uremia and has since been undergoing regular hemodialysis. Ten months prior to her current admission, she experienced excruciating pain and was diagnosed with calciphylaxis. Additionally, an electrocardiogram revealed atrial fibrillation, while echocardiography indicated that the aortic and mitral mechanical valves were appropriately positioned, with normal perivalvular surroundings and good valve leaflet activity. No noticeable thrombosis was observed in the left atrium or left atrial appendage. Color Doppler imaging showed moderate stenosis in the lower extremity arteries, with no venous thromboembolism present. Extensive eggshell-like calcification within the arterial media was detected. The patient was managed with regular hemodialysis, symptomatic treatments (including anticoagulation and analgesia), and sodium thiosulfate. Unfortunately, symptomatic management provided limited relief, and during the one-month follow-up period, the patient passed away due to septic shock. Currently, there is insufficient conclusive evidence regarding alternative influential anticoagulants or appropriate prosthetic valve selection. For individuals with ESKD receiving maintenance hemodialysis, early identification, diagnosis, and treatment of calciphylaxis are of paramount importance.
Collapse
Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mingjing Guan
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaomiao Ruan
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Zhong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
10
|
Liu Y, Zhang X. Early diagnosis strategy of calciphylaxis in dialysis patients. Ren Fail 2023; 45:2264407. [PMID: 37795796 PMCID: PMC10557543 DOI: 10.1080/0886022x.2023.2264407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
Calciphylaxis, a rapidly progressive and potentially life-threatening vascular calcification syndrome that clinically presents with persistently painful, ulcerative, or necrotizing skin lesions in multiple parts of the body, is predominantly observed in patients treated with dialysis. Early diagnosis of calciphylaxis is a key measure for reducing high disability and mortality. At present, there is no unified diagnostic standard for calciphylaxis, and there is a lack of effective early screening strategies. This paper summarized and discussed the diagnostic accuracy of calciphylaxis based on the latest research worldwide. We propose a modified strategy for the early diagnosis of calciphylaxis, which is suitable for dialysis patients to help clinicians better identify such disease and improve prognosis.
Collapse
Affiliation(s)
- Yuqiu Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University, School of Medicine, Nanjing, Jiangsu, China
| | - Xiaoliang Zhang
- Institute of Nephrology, Zhong Da Hospital, Southeast University, School of Medicine, Nanjing, Jiangsu, China
| |
Collapse
|
11
|
Swoboda L. Clinical management of nonuremic calcific arteriolopathy: a report of three cases. Wounds 2023; 35:E275-E281. [PMID: 37769285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Calcific arteriolopathy involves the deposition of insoluble calcium salts in the vasculature and soft tissues, leading to ischemia, thrombosis, and cutaneous necrosis. Calcific arteriolopathy is commonly associated with ESRD but can also occur outside of ESRD, known as NUC. OBJECTIVE This article reviews the clinical management and outcomes of 3 cases of non-uremic calcific arteriolopathy. MATERIALS AND METHODS This case series describes the clinical presentation and successful treatment of NUC in a community hospital-based outpatient wound center in southeastern Wisconsin. Factors presumed to be involved included chronic kidney disease-associated mineral bone disorder, dysregulation and deficiencies of the inhibitors of vascular calcifications, autoimmune dysfunction, and chronic inflammation. All 3 patients received multimodal treatment with wound hygiene, pain management, and infection control. In addition to these interventions, case 2 received NLFU. RESULTS All 3 patients displayed increased tolerance of compression and debridement and successfully epithelialized with no discernible effect on long-term function or quality of life. Wound infection occurred in each case. The mean overall healing time was 20 weeks. CONCLUSION The study findings suggest that successful management of NUC can be achieved using IV STS, early and aggressive infection treatment, pain control, and wound hygiene. In patients with NUC, NLFU may be an appropriate adjunct to expedite healing.
Collapse
Affiliation(s)
- Laura Swoboda
- Froedtert and the Medical College of Wisconsin Community Hospital Division, Wound and Ostomy, Menomonee Falls, WI
| |
Collapse
|
12
|
Luo S, Feng Y, Zhou Y. Calciphylaxis causing skin gangrene in an old woman with end-stage renal disease. Indian J Dermatol Venereol Leprol 2023; 89:792. [PMID: 37436012 DOI: 10.25259/ijdvl_525_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 05/02/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Shuaihantian Luo
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Feng
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zhou
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
14
|
Pyle HJ, Shedd CM, Begovic J, Thomas C, Vandergriff TW, Mauskar MM, Dominguez AR. Complications and Histopathological Findings of Image-Guided Core Needle Biopsy in Diagnosis of Cutaneous Calciphylaxis. Am J Dermatopathol 2023; 45:414-417. [PMID: 37073994 DOI: 10.1097/dad.0000000000002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Hunter J Pyle
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christine M Shedd
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jovan Begovic
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Travis W Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX; and
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
15
|
Jarrett O, Heydari H, Elder Z, Casadesus D. Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment. BMJ Case Rep 2023; 16:e254925. [PMID: 37130645 PMCID: PMC10163535 DOI: 10.1136/bcr-2023-254925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient's symptoms improved.
Collapse
Affiliation(s)
- Omar Jarrett
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, St George's University, Great River, New York, USA
| | - Hamed Heydari
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Zachary Elder
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Damian Casadesus
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| |
Collapse
|
16
|
Abstract
ABSTRACT Calciphylaxis is an uncommon condition most often seen in patients with end-stage renal disease. It is easily mistaken for other more common conditions and requires a high level of suspicion to make a timely diagnosis. Although various treatments such as IV sodium thiosulfate and bisphosphonates have been used for management, calciphylaxis remains a condition with a high mortality that requires an interdisciplinary approach for optimal management.
Collapse
Affiliation(s)
- Chelsea Makowicz
- Chelsea Makowicz is a lieutenant commander in the US Public Health Service and practices at Federal Medical Center Devens, part of the Federal Bureau of Prisons, in Ayer, Mass. The author has disclosed no potential conflicts of interest, financial or otherwise. Opinions expressed in this article are those of the author and do not necessarily represent the opinions of the Federal Bureau of Prisons or the Department of Justice
| |
Collapse
|
17
|
Ficenec S, Gerstein B, Shamburger CD. Calcific uraemic arteriolopathy presenting as cellulitis of the dorsal foot. BMJ Case Rep 2023; 16:e251758. [PMID: 37015767 PMCID: PMC10083774 DOI: 10.1136/bcr-2022-251758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Calcific uraemic arteriolopathy (CUA) is a rare and poorly understood entity that typically presents with painful lesions affecting adipose-rich areas of the lower extremities. We report an unusual case of CUA presenting as presumed cellulitis of the dorsal surface of the distal lower extremity with acute development of a bullous lesion. As CUA incidence is predicted to increase due to its relationship with end-stage renal disease, recognising the full clinical spectrum of this disease is essential to promote further understanding of this disorder and exploration of additional therapeutics to limit disease morbidity and mortality.
Collapse
Affiliation(s)
- Samuel Ficenec
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brittany Gerstein
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | |
Collapse
|
18
|
Gholizadeh Ghozloujeh Z, Rajasekaran A, Abdipour A, Norouzi S. Calciphylaxis in a Patient With Lupus Nephritis and Acute Kidney Injury: A Rare Case Report and Literature Review. J Investig Med High Impact Case Rep 2023; 11:23247096231215705. [PMID: 38097351 PMCID: PMC10725146 DOI: 10.1177/23247096231215705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Calciphylaxis is a rare and severe disease characterized by calcification, fibrosis, and thrombosis of small blood vessels. Although it primarily affects patients with end-stage renal disease (ESRD) on dialysis, limited cases have been reported of calciphylaxis in patients with acute kidney injury (AKI) and lupus. This case report describes the occurrence of calciphylaxis in a 35-year-old female recently diagnosed with lupus nephritis class IV and AKI requiring dialysis.
Collapse
|
19
|
Wang NN, Qin LJ, Liu K, Xing CY, Zhang J, Xiao YJ, Cui YG, Ning S, Yuan YG, Lu Y, Zhang ZH, Su ZL, Ye XX, Bian AN, Zeng M, Wang Q, Xu FY, Ren WK, Lyu XL, Wang L, Zhao J, Wang ML, Ma X, Liu CP, Wang XQ, Liang NX, Liu JY. [Multidisciplinary regenerative treatment and mechanisms for rescuing a severe calciphylaxis patient with human amnion-derived mesenchymal stem cells]. Zhonghua Yi Xue Za Zhi 2022; 102:2217-2221. [PMID: 35872588 DOI: 10.3760/cma.j.cn112137-20211218-02819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Calciphylaxis is a rare disease with severe pain and high-mortality due to cutaneous ischemic necrosis and infection that currently lacks proved effective therapies. The occurrence of calciphylaxis in end stage kidney disease (ESKD) patients is known as calcific uremic arteriolopathy (CUA), which is characterized histologically by dermal microvessel calcification, intimal fibroplasia and microthrombosis. Here we innovatively treated a severe CUA patient with human amnion-derived mesenchymal stem cells (hAMSCs). A 34-year-old uremic woman was presented with progressive, painful malodorous ulcers in buttocks and mummified lower limbs. Skin pathological features supported the diagnosis of calciphylaxis. The patient was refractory to conventional multidisciplinary symptomatic therapies. With the approval of our hospital ethics committee, she was treated with hAMSCs including intravenous and local intramuscular injection, and external application of hAMSC culture supernatant to the wound area. During 15-month follow-up, the patient had regeneration of skin and soft tissues, with improved blood biochemical, inflammatory, mineral and bone metabolic indices and immunoregulation effects. After 15-month hAMSC treatment, the score of pain visual analog scale (VAS) decreased from 10 to 0, Bates-Jensen wound assessment tool (BWAT) score decreased from 65 to 13, and wound-quality of life (Wound-QoL) questionnaire score decreased from 68 to 0. We propose that hAMSC treatment is promising for CUA patients. The therapy is potentially involved in the multiple beneficial effects of inhibiting vascular calcification, stimulating angiogenesis and myogenesis, modulating adverse inflammatory and immunologic responses, promoting re-epithelialization and restoring skin integrity.
Collapse
Affiliation(s)
- N N Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L J Qin
- State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210036, China
| | - K Liu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - C Y Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Zhang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y J Xiao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y G Cui
- State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210036, China
| | - S Ning
- State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210036, China
| | - Y G Yuan
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y Lu
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Z H Zhang
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Z L Su
- Department of Dermatology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X X Ye
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - A N Bian
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - M Zeng
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Q Wang
- Department of Rheumatology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - F Y Xu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - W K Ren
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X L Lyu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Zhao
- Department of Outpatient, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029 China
| | - M L Wang
- Department of Obstetrics, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029 China
| | - X Ma
- State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210036, China
| | - C P Liu
- Department of Biological Specimen Repository, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029 China
| | - X Q Wang
- Department of International Cooperation, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - N X Liang
- Academy of Clinical and Translational Research, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Liu
- State Key Laboratory of Reproductive Medicine, Center of Clinical Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210036, China
| |
Collapse
|
20
|
Rick J, Strowd L, Pasieka HB, Saardi K, Micheletti R, Zhao M, Kroshinsky D, Shinohara MM, Ortega-Loayza AG. Calciphylaxis: Part I. Diagnosis and pathology. J Am Acad Dermatol 2022; 86:973-982. [PMID: 35114300 DOI: 10.1016/j.jaad.2021.10.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022]
Abstract
Calciphylaxis is an uncommon but devastating disorder characterized by vascular calcification and subsequent cutaneous tissue necrosis. This results in exquisitely painful and slow healing wounds that portend exceptionally high morbidity and mortality. The diagnosis of this condition can be complicated because there are no conclusive serologic, radiographic or visual signs that this disease is manifesting. The differential of tissue necrosis is broad, and identifying calciphylaxis requires an adroit understanding of the risk factors and physical signs that should raise suspicion of this condition. Reviews on this subject are uncommon and lack directed commentary from disease experts on the best diagnostic approach for patients suffering from this disease. The goal of this article is to update practicing dermatologists on the current standard of care for calciphylaxis.
Collapse
Affiliation(s)
- Jonathan Rick
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lindsay Strowd
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Helena B Pasieka
- Georgetown University School of Medicine, Washington, DC; Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Karl Saardi
- Georgetown University School of Medicine, Washington, DC
| | - Robert Micheletti
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Megan Zhao
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Michi M Shinohara
- University of Washington Division of Dermatology, Seattle, Washington
| | | |
Collapse
|
21
|
Byers A, Herrera N, Owoyemi I. Chronic inflammation and calciphylaxis. BMJ Case Rep 2022; 15:e248668. [PMID: 35487645 PMCID: PMC9058681 DOI: 10.1136/bcr-2021-248668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/04/2022] Open
Abstract
Calciphylaxis also known as calcific uraemic arteriolopathy is a rare condition mostly seen in patients with end-stage kidney disease. We report a case of a simultaneous-kidney-pancreas transplant patient with functioning grafts developing biopsy-proven calciphylaxis in the setting of chronic inflammation. Despite several modalities of management, the patient developed progression of her disease leading to multiple amputations. This case illustrates chronic inflammation driven by persistent infection as a probable contributing factor to the development and progression of calciphylaxis in a simultaneous kidney-pancreas recipient. Calciphylaxis should be considered in the differential for a painful, non-healing ulcer even in the absence of common risk factors.
Collapse
Affiliation(s)
- Aaron Byers
- Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nicholas Herrera
- Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Itunu Owoyemi
- Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
22
|
Frenken BA, Reichert LJ. [Calciphylaxis, a life-threatening condition in dialysis patients]. Ned Tijdschr Geneeskd 2022; 166:D6379. [PMID: 35138712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Calcification can be seen vascular, peritoneal and also subcutaneous. Subcutaneous calcifications are seen in calciphylaxis, which is a rare but life-threatening condition with painful skin lesions and varying stages of skin necrosis, mostly described in patients on dialysis. CASE DESCRIPTION A 65-year old man presented at the emergency room with complaints of abdominal pain. He had a long history of chronic kidney disease, currently on hemodialysis after previous peritonitis from peritoneal dialysis. Physical examination shows painful plate-like areas of indurated skin on the abdomen with possible central spots of necrosis, suspicious for calciphylaxis. CT-scan showed calcifications on multiple sides. Unfortunately it was already in an advanced stage. He died a few days after hospitalization. CONCLUSION Recognition of calciphylaxis at an early stage is important to prevent and reduce mortality by elimination of risk factors, prevention of infection, pain relief, increasing frequency and length of dialysis, and administration of sodium thiosulfate.
Collapse
|
23
|
Hamedoun L, Mohamed T. Penile calciphylaxis: rare and unrecognized disease. Pan Afr Med J 2022; 41:124. [PMID: 35480413 PMCID: PMC9011911 DOI: 10.11604/pamj.2022.41.124.33602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Larbi Hamedoun
- Service of Urology, Military Hospital of Instruction Mohamed V, Hay Ryad, Rabat, Morocco
- Corresponding author: Larbi Hamedoun, Service of Urology, Military Hospital of Instruction Mohamed V, Hay Ryad, Rabat, Morocco.
| | - Tetou Mohamed
- Service of Urology, Military Hospital of Instruction Mohamed V, Hay Ryad, Rabat, Morocco
| |
Collapse
|
24
|
Gabel CK, Blum AE, François J, Chakrala T, Dobry AS, Garza-Mayers AC, Ko LN, Nguyen ED, Shah R, John JS, Nigwekar SU, Kroshinsky D. Clinical mimickers of calciphylaxis: A retrospective study. J Am Acad Dermatol 2021; 85:1520-1527. [PMID: 33744358 DOI: 10.1016/j.jaad.2021.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Calciphylaxis is an ischemic vasculopathy with high morbidity and mortality. Early and accurate diagnosis is critical to management of calciphylaxis. Clinical mimickers may contribute to delayed or misdiagnosis. OBJECTIVE To assess the rate and risk factors for misdiagnosis and to identify clinical mimickers of calciphylaxis. METHODS A retrospective medical record review was conducted of patients with calciphylaxis at a large urban tertiary care hospital between 2006 and 2018. RESULTS Of 119 patients diagnosed with calciphylaxis, 73.1% were initially misdiagnosed. Of patients not initially misdiagnosed, median time to diagnosis from initial presentation was 4.5 days (interquartile range, 1.0-23.3), compared to 33 days (interquartile range, 13.0-68.8) in patients who were initially misdiagnosed (P = .0002). The most common misdiagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). Patients who were misdiagnosed frequently received at least 1 course of antibiotics. Patients with end-stage renal disease were less likely to be misdiagnosed than those without this disease (P = .001). LIMITATIONS Single-center, retrospective study. CONCLUSIONS Understanding the risk factors for misdiagnosis of calciphylaxis is an opportunity for further education concerning this rare disease.
Collapse
Affiliation(s)
- Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy E Blum
- Harvard Medical School, Boston, Massachusetts
| | | | - Teja Chakrala
- Narayana Medical College and Hospital, Nellore, India
| | - Allison S Dobry
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | | | - Lauren N Ko
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Emily D Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Radhika Shah
- Department of Dermatology, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jessica St John
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sagar U Nigwekar
- Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
25
|
Mitchell-Brown F, Stephens E. Penile calciphylaxis: A case study. Nursing 2021; 51:44-47. [PMID: 34807862 DOI: 10.1097/01.nurse.0000800068.33963.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Fay Mitchell-Brown
- Fay Mitchell-Brown is an associate professor at California State University, Chico, where Elena Stephens is a nursing student
| | | |
Collapse
|
26
|
Abrantes PG, Castañon MCMN, Rochael MC, de Lacerda Bonfante H. Calciphylaxis in Systemic Lupus Erythematosus: A Diagnostic Challenge. J Clin Rheumatol 2021; 27:S398-S400. [PMID: 32649409 DOI: 10.1097/rhu.0000000000001467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Killeen E, Traynor C, O'Seaghdha C. Painful skin lesion in a patient on haemodialysis: a diagnosis not to miss. BMJ Case Rep 2021; 14:e245323. [PMID: 34728508 PMCID: PMC8565538 DOI: 10.1136/bcr-2021-245323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/03/2022] Open
Abstract
An 81-year-old man was admitted under the care of a plastic surgery team with a 10-day history of a painful left lower leg skin lesion after a punch biopsy of a naevus. His background history includes end-stage kidney disease secondary to hypertensive nephropathy, on intermittent haemodialysis via fistula. Other significant background history includes stroke, hypertension and ischaemic heart disease with coronary artery stents. There was no history of warfarin use. He was initially treated with a 5-day course of oral antibiotics with no improvement. He was referred to the hospital where he was admitted under the plastic surgery team who had completed the punch biopsy for intravenous antibiotics for presumed cellulitis. During his admission, the nephrology service were consulted to prescribe routine inpatient haemodialysis. Further history taking and wound review identified a 10-day history of an extremely painful skin lesion with an eschar and surrounding dusky, purpuric skin. Given the disproportionate pain and black eschar which are not in keeping with cellulitis, a diagnosis of calciphylaxis was made. He was commenced sodium thiosulfate on haemodialysis.
Collapse
Affiliation(s)
- Emily Killeen
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carol Traynor
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conall O'Seaghdha
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
28
|
Pallás IM, Torres AM, Espés ML. Penile Calciphylaxis: A Severe Entity Difficult to Diagnose. Skinmed 2021; 19:308-309. [PMID: 34526208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
|
29
|
Sloan SB. Early recognition and intervention of calciphylaxis. J Am Acad Dermatol 2021; 85:837. [PMID: 34293390 DOI: 10.1016/j.jaad.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Steven Brett Sloan
- Department of Dermatology, University of Connecticut School of Medicine, Newington, Connecticut.
| |
Collapse
|
30
|
Nguyen NT, Shakir MKM, Hoang TD. Calcinosis cutis in a renal transplant patient. BMJ Case Rep 2021; 14:e242610. [PMID: 33975849 PMCID: PMC8117999 DOI: 10.1136/bcr-2021-242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/03/2022] Open
Abstract
Calcinosis cutis is an unusual disorder characterised by calcium-phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Our objective was to report a patient with a history of haemodialysis-dependent end-stage renal disease (ESRD) who developed metastatic calcinosis cutis, which is usually associated with abnormalities of calcium-phosphate metabolism in renal failure. In our patient, the serum calcium and phosphate levels were normal. Additionally, we describe the diagnostic approach and the difficulties involved in the management of calcinosis cutis in patients with haemodialysis-dependent ESRD.
Collapse
Affiliation(s)
- Nguyen T Nguyen
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Mohamed K M Shakir
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Endocrinology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thanh Duc Hoang
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Endocrinology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
31
|
Ackermann M, Humbert A, Stucker F. [When necrosis threatens the kidney patient…]. Rev Med Suisse 2021; 17:394-398. [PMID: 33625805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Calciphylaxis is a rare but devastating condition characterized by a calcifying thrombosing microangiopathy resulting in painful necrotic skin lesions. Risk factors are multiple, the most important being obesity, disorders of phosphocalcic metabolism and acenocoumarol. Largely unknown by the medical community, its pathogenesis is still incompletely elucidated; its diagnosis by skin biopsy remains difficult and increasingly debated because potentially associated with an aggravation of lesions. Its treatment must be as premature as possible andmultimodal. However, the results are up to now unsatisfactory, as specific treatment of calciphylaxis does not yet exist.
Collapse
Affiliation(s)
- Mélanie Ackermann
- Service de néphrologie et d'hypertension artérielle, Département de médecine, Réseau hospitalier neuchâtelois, 2000 Neuchâtel
| | - Antoine Humbert
- Service de néphrologie et d'hypertension artérielle, Département de médecine, Réseau hospitalier neuchâtelois, 2000 Neuchâtel
| | - Fabien Stucker
- Service de néphrologie et d'hypertension artérielle, Département de médecine, Réseau hospitalier neuchâtelois, 2000 Neuchâtel
| |
Collapse
|
32
|
Rostoker G, Senet P, Lepeytre F, Griuncelli M, Loridon C, Rabaté C, Cohen Y. Analysis of liver iron concentration in an elderly female undergoing hemodialysis with calcific uremic arteriolopathy does not support the role of iron overload in calciphylaxis: lesson for the clinical nephrologist. J Nephrol 2021; 34:1547-1551. [PMID: 33484427 PMCID: PMC8494698 DOI: 10.1007/s40620-020-00904-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Guy Rostoker
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France.
- Collège de Médecine des Hôpitaux de Paris, 10 Rue des Fossés Saint-Marcel, 75005, Paris, France.
- Service de Néphrologie et de Dialyse, Ramsay Santé, HP Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France.
| | - Patricia Senet
- Division of Dermatology and Allergology, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France
| | - Fanny Lepeytre
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
| | - Mireille Griuncelli
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
| | - Christelle Loridon
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
| | - Clémentine Rabaté
- Division of Nephrology and Dialysis, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
| | - Yves Cohen
- Division of Radiology, Ramsay Santé, Hôpital Privé Claude Galien, 20 Route de Boussy-Saint-Antoine, 91480, Quincy-Sous-Sénart, France
| |
Collapse
|
33
|
Soloway AM, Arkebauer MR, Soloway S. Nonuremic Calciphylaxis. J Clin Rheumatol 2020; 26:e83-e84. [PMID: 32453301 DOI: 10.1097/rhu.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Garelik J, Terushkin V, Nagler A, Hale C, Kamino H, McLellan B. An unusual presentation of calciphylaxis. Cutis 2020; 105:E24-E27. [PMID: 32352446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jessica Garelik
- Department of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Vitaly Terushkin
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Arielle Nagler
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Chris Hale
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Hideko Kamino
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
| | - Beth McLellan
- Department of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
35
|
Abstract
Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.
Collapse
Affiliation(s)
- O El-Taji
- Department of Urology, Lister Hospital, Stevenage, UK
| | - J Bondad
- Department of Urology, Lister Hospital, Stevenage, UK
| | - S Faruqui
- Department of Urology, Lister Hospital, Stevenage, UK
| | - J Bycroft
- Department of Urology, Lister Hospital, Stevenage, UK
| |
Collapse
|
36
|
Liebman TN, Tamez R, Daly JA. Calciphylaxis in Association with Alcoholic Cirrhosis and Hepatorenal Syndrome. Skinmed 2020; 18:46-49. [PMID: 32167457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 45-year-old woman with cirrhosis secondary to alcohol abuse was transferred from an outside hospital for management of a painful cutaneous eruption, progressively worsening over 2 weeks. On examination, the patient was a middle-aged white woman lying in bed in no acute distress, with jaundice and a protuberant abdomen consistent with ascites. The patient was afebrile (98.2°F), heart rate of 79 beats per minute, blood pressure of 105/61 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 93% on room air. She had multiple large stellate lesions of retiform purpura with central hemorrhagic necrosis on both thighs, with surrounding induration (Figures 1 and 2). These purpuric plaques and perilesional skin were exquisitely painful to palpation.
Collapse
Affiliation(s)
- Tracey N Liebman
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine; New York, NY
| | - Rebecca Tamez
- Department of Dermatology, Hofstra Northwell School of Medicine, Manhasset, NY
| | - Jeanine A Daly
- Department of Dermatology, Hofstra Northwell School of Medicine, Manhasset, NY;
| |
Collapse
|
37
|
Kolb LJ, Ellis C, Lafond A. Nonuremic calciphylaxis triggered by rapid weight loss and hypotension. Cutis 2020; 105:E11-E14. [PMID: 32074157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Calciphylaxis is a potentially fatal disease caused by metastatic calcification of the small- and medium-sized blood vessels of the dermis and subcutis. It most commonly is seen in patients with renal disease requiring dialysis, but it also may be triggered by nonuremic causes in patients with known risk factors for calciphylaxis. We report a case of nonuremic calciphylaxis (NUC) occurring in the setting of multiple risk factors, including chronic corticosteroid use, obesity, rapid weight loss, and hypotension. A review of the literature also is provided with an in-depth discussion of the known risk factors and triggers of NUC.
Collapse
Affiliation(s)
- Logan J Kolb
- Department of Dermatology, Orange Park Medical Center, Florida, USA
| | - Carolyn Ellis
- Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| | - Ann Lafond
- Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| |
Collapse
|
38
|
|
39
|
Mahé A. [What's new in clinical dermatology?]. Ann Dermatol Venereol 2019; 145 Suppl 7:VIIS1-VIIS10. [PMID: 30583751 DOI: 10.1016/s0151-9638(18)31283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this article, we performed a review of all new data of clinical relevance for the dermatologists that were published in the medical literature between September, 2017 and September, 2018. Besides advances that will be useful in day-to-day dermatological practice, we intended to give a more general perspective to this review by taking into account certain international health issues that might in final concern each of us in a globalized world. Focus were more particularly done on the following topics: infectious diseases (including sexually transmitted infections), neglected tropical diseases, adverse effects of drugs, bullous diseases, allergology, wound healing, dermatology on black skin, and public health dermatology.
Collapse
Affiliation(s)
- A Mahé
- Service de dermatologie, hôpital Louis-Pasteur, 68024 Colmar cedex, France.
| |
Collapse
|
40
|
Kusari A, Cotter D, Hinds B, Paravar T. Non-uremic calciphylaxis in a patient with multiple rheumatologic diseases. Dermatol Online J 2019; 25:13030/qt2fg525bs. [PMID: 30865406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023] Open
Abstract
Non-uremic calciphylaxis is a rare, life-threatening condition characterized clinically by cutaneous necrosis and histologically by calcium deposition in small vessel walls. The etiology of non-uremic calciphylaxis remains the subject of ongoing speculation and debate. Herein we present a patient with calciphylaxis who had normal kidney function and numerous rheumatologic diseases, namely systemic lupus erythematosus (SLE), Sjogren syndrome (SS), and myasthenia gravis (MG). We review the pathophysiology, possible mechanisms, and management for non-uremic calciphylaxis.
Collapse
Affiliation(s)
- Ayan Kusari
- Department of Dermatology, University of California, San Diego School of Medicine, La Jolla, California.
| | | | | | | |
Collapse
|
41
|
Villela-Segura U, Peralta-Serna J, Guerrero-Álvarez A, Estrada-Aguilar L. Glans penis necrosis caused by calcific uremic arteriolopathy. Dermatol Online J 2019; 25:13030/qt2kg3n28d. [PMID: 30865408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023] Open
Abstract
Calcific uremic arteriolopathy (CUA) or calciphylaxis is a syndrome characterized by calcification of vessels located in the dermis and adipose tissue. It commonly occurs in patients with diabetes mellitus, hypertension, and end-stage renal disease. Clinical presentation generally begins with severe pain, followed by the presence of liveloid or purpuric plaques. Later the formation necrotic ulcers occur. This condition is associated with a poor prognosis, with a high rate of mortality within months of the diagnosis. Penile involvement is an uncommon but severe manifestation. We present an 81-year-old man with a history of diabetes mellitus, hypertension, and end-stage renal disease with a one-month evolution of painful necrotic ulcers on his glans penis. He was diagnosed with CUA. Owing to infection complicated by sepsis; penectomy was performed. Unfortunately, the patient died of myocardial infarction during his hospitalization.
Collapse
Affiliation(s)
- Uriel Villela-Segura
- Dermatology Unit, Hospital Regional "Licenciado Adolfo López Mateos", ISSSTE, Mexico City.
| | | | | | | |
Collapse
|
42
|
Abstract
Calciphylaxis is a disease of significant morbidity and mortality, predominantly affecting dialysis patients. The term 'calciphylaxis' was coined by Seyle et al. in 1961 to describe calcium deposition in the skin and subcutaneous soft tissue of uremic rats in response to 'triggers' (e.g. trauma, metallic salts) after exposure to 'sensitizing agents' (e.g. vitamin D and parathyroid hormone). In humans, calciphylaxis, however, is not a disorder of induced hypersensitivity. Instead, it is a disorder of cutaneous microvascular occlusion caused by thrombosis and calcification. Progressive, excruciatingly painful, non-healing wounds develop in these patients, pre-disposing them to high risk of sepsis and death. Calciphylaxis has no approved therapies. Increased awareness and research in this field have facilitated identification of risk factors and causation pathways. Development of therapeutic options and wound care management, however, are still at a nascent stage. Certain therapies have shown a promise that needs evaluation in prospective clinical trials. It is hoped that ongoing research will help us better understand the pathogenesis of this complex disease and develop efficacious treatment options. In this review, we outline the components involved in calciphylaxis diagnosis and treatment.
Collapse
Affiliation(s)
- H Seethapathy
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V M Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas Klinikum, Würselen, Germany
| | - S Sinha
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK
| | - R A El-Azhary
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - S U Nigwekar
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
43
|
Kale G, Jeloka T, Shrividya S, Mulay A, Deshmukh M, Krishnan S, Nigwekar S. Calciphylaxis in a renal transplant recipient with normal graft function: A case report and review of literature. Saudi J Kidney Dis Transpl 2019; 30:215-220. [PMID: 30804284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, life-threatening complication of end-stage renal disease. However, it may also occur in patients without renal failure, the nonuremic calciphylaxis. Most patients present with painful skin ulcers. Delayed diagnosis can lead to sepsis-related morbidity and mortality. Aberrations in calcium, phosphate, and parathyroid hormone physiology are common and biopsy is diagnostic. Early diagnosis and correction of vascular and metabolic aberrations may assist in healing as may the use of sodium thiosulfate and hyperbaric oxygen therapy. We report on successful treatment of a case of calciphylaxis in a renal transplant recipient with normal allograft function.
Collapse
Affiliation(s)
- Gajanan Kale
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Tarun Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - S Shrividya
- Department of Pathology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Atul Mulay
- Department of Nephrology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Manisha Deshmukh
- Department of Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - S Krishnan
- Department of Nephrology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Sagar Nigwekar
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| |
Collapse
|
44
|
Khanna U, Dominguez A, Keller J, Kroshinsky D, Ortega-Loayza AG, Strowd L, Micheletti RG. Update on calciphylaxis etiopathogenesis, diagnosis, and management. Cutis 2018; 102:395-400. [PMID: 30657805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Calciphylaxis is a rare painful skin condition classically seen in patients with end-stage renal disease (ESRD), particularly those on chronic dialysis; however, it also has been increasingly reported in patients with normal renal function. Calciphylaxis is associated with high mortality rates, and excruciating pain and nonhealing ulcers often lead to recurrent hospitalizations and infectious complications. It is critical for dermatologists to recognize the clinical features of calciphylaxis to ensure accurate and timely diagnosis and proper management. In this article, we provide an update on calciphylaxis etiopathogenesis, diagnosis, and management, and we highlight the challenges faced in managing this potentially fatal condition.
Collapse
Affiliation(s)
- Urmi Khanna
- Department of Dermatology, Cleveland Clinic, Ohio, USA
| | - Arturo Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jesse Keller
- Department of Dermatology, Oregon Health and Science University, Portland, USA
| | | | | | - Lindsay Strowd
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert G Micheletti
- Departments of Dermatology and Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
45
|
Zhou Y, Zhang H, Sun J, Ji Y, Liu J. [Early diagnosis, prevention and treatment for calcific uremic arteriolopathy]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2018; 43:1251-1256. [PMID: 30643072 DOI: 10.11817/j.issn.1672-7347.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Calcific uremic arteriopathy (CUA), termed calciphylaxis, is a rare but highly fatal clinical syndrome. There is no clearly laboratory diagnostic criteria for CUA. The medium and small arterial calcification and microthrombosis discovered by skin biopsy, radiologic imaging,bone scan and the evidence of activation of the bone morphogenetic protein signal (BMPs) transduction pathway are useful for early diagnosis of this disease. The common therapies (including intravenous sodium thiosulfate (STS) and bisphosphonates, hyperbaric oxygen therapy and other symptomatic supports) are used for the management of wounds, pain, nutrition, dialysis and so on. Controlling the chronic kidney disease-mineral and bone disorder (CKD-MBD) and some complications of dialysis and drugs (such as warfarin, active vitamin D) can prevent CUA. However, CUA patients still have poor prognosis and high mortality. Since some patients progress rapidly, it is of great importance to make early diagnosis and provide effective treatments with multidisciplinary management.
Collapse
Affiliation(s)
- Yueyi Zhou
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Hao Zhang
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jian Sun
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ying Ji
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jishi Liu
- Department of Nephrology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| |
Collapse
|
46
|
Weidner T, Elsner P. Acral Necroses. Dtsch Arztebl Int 2018; 115:645. [PMID: 30375326 PMCID: PMC6224541 DOI: 10.3238/arztebl.2018.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Till Weidner
- *Klinik für Hautkrankheiten, Universitätsklinkum Jena,
| | - Peter Elsner
- *Klinik für Hautkrankheiten, Universitätsklinkum Jena,
| |
Collapse
|
47
|
Stârcea M, Gavrilovici C, Elsayed A, Munteanu M, Lupu VV, Cojocaru E, Miron I, Miron L. A case report of pediatric calciphylaxis-a rare and potentially fatal under diagnosed condition. Medicine (Baltimore) 2018; 97:e11300. [PMID: 29979398 PMCID: PMC6076114 DOI: 10.1097/md.0000000000011300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Though to be rare, calcific uremic arteriolophathy (CUA) is an ectopic calcification entity causing pain and disabilities in patients with chronic renal insufficiency, thus increasing the morbidity and mortality. PATIENT CONCERN We report a case of four years old boy admitted with acute respiratory failure. Physical examination revealed: irritability, purple subcutaneous hard nodules, tachypnea, dry spasmodic cough, respiratory rate 45/min, heart rate 110/min, blood pressure 100/60 mmHg, with normal heart sounds, no murmurs, hepatomegaly with hepato-jugular reflux. He was diagnosed at 2 years old with stage 5 chronic kidney disease due to untreated posterior urethral valve, and subsequently started peritoneal dialysis. He developed severe renal osteodystrophy, refractory to standard phosphate binders. DIAGNOSES Pathology examination revealed the presence of diffuse calcifications involving the skin, brain, heart, lung, kidney, stomach and pancreas, consistent with the underlying diagnosis of CUA. INTERVENTION Apart from standard treatment for end stage renal disease and associated co-morbidities, intensive care procedures have been initiated: oxygen therapy, continuous positive airway pressure, inotropic medication (Dopamine, Dobutamine), anticonvulsants (Diazepam), and antiedematous therapy (Dexamethasone). OUTCOME His pulmonary function rapidly deteriorated up to the severe hypoxemia, seizures and cardio-respiratory arrest, despite the initiation of intensive care measures. LESSONS A careful follow up of small children might detect in time an abnormal urinary pattern. The diagnosis of growth failure should also trigger urgent further investigation.
Collapse
Affiliation(s)
| | | | - Andra Elsayed
- Sf Maria Emergency Hospital for Children Iasi, Department of Pediatric Nephrology, Romania
| | - Mihaela Munteanu
- Sf Maria Emergency Hospital for Children Iasi, Department of Pediatric Nephrology, Romania
| | | | - Elena Cojocaru
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| | - Ingrith Miron
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| | - Lucian Miron
- University of Medicine and Pharmacy Grigore T. Popa Iasi
| |
Collapse
|
48
|
Affiliation(s)
- Sagar U Nigwekar
- From the Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston (S.U.N., R.T.); the Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Los Angeles (R.T.); and the Department of Cardiology, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen University Hospital, Aachen (V.M.B.), and the Department of Cardiology, Rhein-Maas Klinikum, Würselen (V.M.B.) - both in Germany
| | - Ravi Thadhani
- From the Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston (S.U.N., R.T.); the Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Los Angeles (R.T.); and the Department of Cardiology, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen University Hospital, Aachen (V.M.B.), and the Department of Cardiology, Rhein-Maas Klinikum, Würselen (V.M.B.) - both in Germany
| | - Vincent M Brandenburg
- From the Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston (S.U.N., R.T.); the Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Los Angeles (R.T.); and the Department of Cardiology, RWTH (Rheinisch-Westfälische Technische Hochschule) Aachen University Hospital, Aachen (V.M.B.), and the Department of Cardiology, Rhein-Maas Klinikum, Würselen (V.M.B.) - both in Germany
| |
Collapse
|
49
|
Marleen Holtsche M, Zillikens D, Shimanovich I. Non-Uremic Calciphylaxis. Dtsch Arztebl Int 2018; 115:265. [PMID: 29735007 PMCID: PMC5949375 DOI: 10.3238/arztebl.2018.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Detlef Zillikens
- * Klinik für Dermatologie, Allergologie und Venerologie, Universitat zu Lübeck,
| | - Iakov Shimanovich
- * Klinik für Dermatologie, Allergologie und Venerologie, Universitat zu Lübeck,
| |
Collapse
|
50
|
Alves C, Ernandez T, Stoermann Chopard C. [Calcific uremic arteriolopathy (calciphylaxis) : update in 2018]. Rev Med Suisse 2018; 14:426-429. [PMID: 29465875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Calciphylaxis is a rare disease with a poor prognostic that mostly occurs in patients with renal failure. Diagnosis is difficult and skin biopsy is the gold standard diagnostic procedure, although it may aggravate skin lesions. Identification of the typical cutaneous signs is important to initiate adequate medical care. Several differential diagnoses must be excluded. Treatments should include appropriate pain management, local wound pain, daily dialysis, intravenous sodium thiosulfate treatment, hyperbaric oxygenotherapy, thigh control of calcium-phosphate metabolism and interruption of medications that could contribute to calciphylaxis. Palliative care should be considered in uncontrolled clinical course.
Collapse
Affiliation(s)
- Cyrielle Alves
- Service de néphrologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Thomas Ernandez
- Service de néphrologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | | |
Collapse
|