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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Calciphylaxis is a severe complication of mineral bone disorder in patients with kidney failure, especially those on dialysis. When it occurs in individuals without Kidney Failure, it is termed non-uraemic calciphylaxis, a rarer entity with unclear pathophysiology and a high mortality rate, often due to sepsis. Increasingly, non-uraemic calciphylaxis is recognized in patients receiving targeted therapies such as fibroblast growth factor receptor inhibitors. Distinguishing calciphylaxis from calcinosis cutis is critical for prognosis and management.
We report a 74-year-old woman with metastatic FGFR2-BICC1 fusion–positive cholangiocarcinoma who developed bilateral calf pain and ulcerative leg lesions after initiating pemigatinib as second-line therapy. Pemigatinib was discontinued after five months due to grade 3 nail toxicity.
Investigations revealed preserved renal function, calcium 2.15–2.24 mmol/L, phosphate 0.46 mmol/L, parathyroid hormone 16–50 pg/mL, vitamin D 79 nmol/L, and markedly elevated FGF23. Skin biopsy showed pauci-inflammatory ischemic necrosis with patchy dermal dystrophic calcification, without evidence of vasculitis or infection. Bone scan and CT angiogram demonstrated diffuse subcutaneous calcification of both lower limbs, consistent with calciphylaxis, although radiologically overlapping with calcinosis cutis.
Due to the uncommon nature of this diagnosis, nephrology consultation was sought with regards to diagnosis and management. Given the patient’s limited prognosis and ongoing cancer progression, intravenous sodium thiosulfate was not administered. Management included topical sodium thiosulfate, vitamin K supplementation, magnesium replacement, withdrawal of calcium and vitamin D, wound care, and palliative analgesia. Multidisciplinary review was undertaken to refine the diagnosis and management plan.
Conclusion: This case illustrates pemigatinib-associated calcific skin disease presenting as probable non-uremic calciphylaxis. Accurate differentiation from calcinosis cutis is essential for guiding therapy, including the judicious use of sodium thiosulfate and other treatments.
