2000 Associates' Presentations
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Recognizing Calciphylaxis: A Case Report
Jennifer Hablewitz, MD, Sinai Samaritan Medical Center, Milwaukee, WI
Calciphylaxis is an uncommon complication of end stage renal disease (ESRD) and secondary hyperparathyroidism. Calcification of the skin and subcutaneous tissues or of internal organs can lead to skin necrosis, ulceration, or other skin lesions. Histology is specific for medial calcification with intimal hyperplasia and thrombosis of the lumen of small sized arteries. Patients often have elevated calcium phosphate product.
Case: A 32-year old female with insulin dependent diabetes mellitus, hypertension, and diabetic nephropathy presented with a nonhealing sacral ulcer. The patient had previously undergone bilateral below the knee amputations, and right second and third digit amputations for presumptive diabetic vasculitis. Patient also had 4 gangrenous digits and was on high dose prednisone for 8 years. Initial labs revealed WBC 22.1, creatinine 5.2 mg/dl, BUN 62 mg/dl, Ca 9.7 mg/dl, phosphorus 6.5 mg/dl, LDH 231, albumin 2.1 mg/dl, alk phos 394 U/L, and PTH 129.8 (10-65 pg/ml). Pathology of right leg tissue showed calcification of the medial layer of the blood vessels. Patient was offered parathyroidectomy, but declined. She was discharged after an antibiotic course and steroid wean.
Discussion: Calciphylaxis is a serious disease and patients often succumb to sepsis and infectious complications. It is important to consider calciphylaxis when treating patients with ESRD and hyperparathyroidism because early diagnosis and treatment may interrupt disease progression. Parathyroidectomy, anticoagulants, and phosphate binders have found anecdotal success, but definite treatment remains elusive.
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Sharon Haase, MD, FACP
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