Calciphylaxis

A 28-year-old male on intermittent hemodialysis (IHD) for 1 year due to eosinophilic granulomatosis with polyangiitis presented with 2 weeks of thigh wounds. Serum studies showed calcium 11.3 mg/dL, albumin 3.8 g/dL, parathyroid hormone (PTH) 340 pg/mL, phosphorous 5.7 mg/dL, and 25-hydroxy vitamin D 31.5 ng/mL. An examination showed a well-demarcated, indurated, violaceous right thigh ulcer (Figure 1). A biopsy showed ulcerated epidermis with little dermal inflammation. Subcuticular blood vessels showed fat necrosis, stippled calcium deposition, and focal vascular thrombosis consistent with calciphylaxis. Sodium thiosulfate (STS) was administered thrice weekly after IHD with antibiotics and debridement. After 2 months of STS, the wound continues healing (Figure 2).

Read the Article