Introduction
Calciphylaxis is a rare but life-threatening condition characterized by calcium deposition in the dermal and subcutaneous arterioles, leading to ischemia, intimal proliferation, and necrosis【1】. Primarily affecting patients with end-stage renal disease (ESRD) undergoing hemodialysis, calciphylaxis presents with painful, necrotic skin lesions and carries a high mortality rate【2】. Prompt recognition is essential for timely management, as delay can lead to significant morbidity and mortality【3】.
Methods
We present the case of a 64-year-old female with a history of ESRD on hemodialysis, along with comorbidities including hypertension, diabetes mellitus, and dyslipidemia. She presented with severely painful, necrotic lesions that had developed over one week in the bilateral areolar regions, medial thighs, and the lateral aspect of her left thigh. (Figure 1) Laboratory investigations revealed changes associated with tertiary hyperparathyroidism. A skin biopsy was performed to confirm the diagnosis. Treatment included the discontinuation of calcium and vitamin D supplementation, optimization of dialysis settings with low-calcium dialysate, and collaboration with a multidisciplinary team including wound care specialists, plastic surgery, and the pain management team.
Results
The skin biopsy confirmed calciphylaxis. (Figure 2) After adjustments in her treatment regimen, including the cessation of calcium supplementation and the use of low-calcium dialysate, her pain was better managed after involving the pain management team. The lesion requires further follow-up to determine its progression. Sodium thiosulphate is planned to be initiated after discharge and to be given after dialysis. Wound care management was crucial in preventing secondary infection. There were no signs of systemic infection during her hospital stay, and she was discharged for outpatient follow-up.
Conclusions:
Calciphylaxis requires early recognition and immediate intervention to improve outcomes【4】. Clinical diagnosis, supported by histopathology, plays a crucial role in identifying the condition 【1】. Effective management hinges on controlling calcium and phosphate levels, optimizing dialysis settings, and involving a multidisciplinary team for wound care and pain management 【2】. This case underscores the importance of maintaining a high index of suspicion in dialysis-dependent patients presenting with necrotic lesions, as prompt intervention can significantly affect the prognosis【3】【4】
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.