Abstract: SA-PO932

Penile Calciphylaxis: Suspicion Is the Key

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Olaoye, Olanrewaju Adebayo, University of Florida, Division of Nephrology, Gainesville, Florida, United States
  • Koratala, Abhilash, None, Gainesville, Florida, United States
Background

Calciphylaxis or calcific uremic arteriolopathy (CUA) is a rare and potentially fatal condition that presents with skin ischemia and necrosis, typically seen in end stage renal disease (ESRD) patients on dialysis. Histologically, it is characterized by medial calcification of dermal arterioles. CUA commonly involves legs, abdomen and gluteal region. Herein, we present a case of CUA of the glans penis.

Methods

An 81-year old white man with history of hypertension and CKD stage 5 was admitted to the hospital for uremic symptoms necessitating initiation of haemodialysis. He complained of pain and redness of the glans penis that first appeared 3 weeks ago. At that time, he was treated for possible balanitis with antibiotics and had partial relief. He denied having any fever, chills, difficulty urinating or discharge from the urethra. On examination, he had purpuric patches, erosions and superficial necrosis of penile glans with minimal tenderness [Figure 1A]. His labs were significant for serum creatinine of 12.7 mg/dl, phosphate 8.4 mg/dl, calcium 9.8 mg/dl, albumin 2.6 g/dl, and parathyroid hormone 1131 pg/ml. CT scan of the abdomen showed extensive calcification of the aorta and pudendal vessels [Figure 1B]. Based on the clinical features and imaging evidence of vascular calcification, we diagnosed him with CUA of the penis

Conclusion

While the definitive diagnosis of CUA requires skin biopsy, it is not routinely recommended for penile lesions because of the risk for progression of necrosis. Risk factors for CUA include White race, CKD-MBD axis abnormalities, obesity, hypercoagulable conditions including protein C and S deficiency, diabetes mellitus, hypoalbuminemia, warfarin use and longer dialysis vintage of over 6-7 years. Management includes intensification of dialysis regimen, phosphate and PTH lowering therapy, and intravenous sodium thiosulfate therapy. Clinicians should be aware of rare presentations of CUA for prompt diagnosis and appropriate treatment