APIXABAN AND SODIUM THIOSULFATE IN CALCIPHYLAXIS: UNEXPECTED SUCCESSFUL COMBINATION THERAPY

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Abstract Title *

APIXABAN AND SODIUM THIOSULFATE IN CALCIPHYLAXIS: UNEXPECTED SUCCESSFUL COMBINATION THERAPY

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Co-author 1

Mouna Jerbi mouna.jerbi@fmt.utm.tn Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department Tunis Tunisia *

Co-author 2

Ibtissem Ben Nacef ibtissem.bennacef@fmt.utm.tn Charles Nicolle Hospital Endocrinology Department Tunis Tunisia -

Co-author 3

Asma Bettaieb asma.bettaieb@fmt.utm.tn Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department tunis Tunisia -

Co-author 4

Raja Aoudia rajoi2000@yahoo.fr Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department tunis Tunisia -

Co-author 5

Mariem Khadhar Meriam.khadhar@fmt.utm.tn Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department tunis Tunisia -

Co-author 6

Sarra Hadded sarra.hadded@fmt.utm.tn Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department tunis Tunisia -

Co-author 7

Rym Goucha rim.goucha@fmt.utm.tn Mongi Slim Hospital, Renal Pathology Research Laboratory, LR00SP01, Faculty of Medicine, University of Tunis El Manar Nephrology Department tunis Tunisia -

Co-author 8

Hayet Kaaroud hayet.kaaroud@fmt.utm.tn Charles Nicolle Hospital Renal Pathology Research Laboratory, LR00SP01 tunis Tunisia -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Calciphylaxis is a rare and life-threatening complication causing ischemic and painful skin lesions. It is mostly seen among patients undergoing dialysis for a long time, but its pathophysiology is multifactorial. It presents a diagnostic and therapeutic challenge for clinicians.

Methods

We present the case of a young female patient on hemodialysis in whom a diagnosis of Caciphylaxis was made, subsequently treated with a combination of Sodium Thiosulfate and Apixaban, and who showed a remarkable improvement.

Results

Here we present the case of a young female patient with systemic lupus erythematosus on dialysis for 3 years. She had early, trophic and very painful lesions began to develop on her lower extremities, gradually progressing to gangrene leading to multiple amputations. Radiological investigations (CT-Scan) revealed extensive vascular and soft tissue calcifications, raising suspicion for Calciphylaxis.

Based on the disease's pathophysiology and the various contributing factors, the patient underwent multidisciplinary management, including optimization of hemodialysis with a low calcium bath, Extension of hemodialysis sessions thanks to the administration of analgesics such as morphine derivatives. We discontinued the treatments that potentially contributed to the progression of the disease, such as vitamin D, corticosteroid and Acenocoumarol and she underwent dozens hyperbaric oxygen therapy (HBOT). Despite these treatments, the pain persisted, and the gangrene lesions worsened indicating the amputation of the fourth toe on her right foot.

A combination therapy of Direct Oral Anticoagulant and Sodium thiosulfate medications led to a significant improvement and disappearance of the majority of lesions after 6 months.

Conclusion

In conclusion, calciphylaxis is a rare but potentially life-threatening condition characterized by vascular calcification and tissue necrosis. Early recognition of risk factors and clinical manifestations is crucial for timely diagnosis and initiation of appropriate interventions. Among the various therapeutic options proposed for this rare and serious condition, the combination of STS and Apixaban appears promising and offers long-term safety

Kewords