Abstract: FR-PO639
Penile Calciphylaxis: A Clinico-Radiologic Diagnosis
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chamarthi, Gajapathiraju, University of Flroida, Gainesville, Florida, United States
- Koratala, Abhilash, University of Florida, Gainesville, Florida, United States
Introduction
Calciphylaxis, also known as calcific uremic arteriolopathy (CUA) is a rare and serious disorder typically seen in ESRD patients that presents with skin ischemia and necrosis and histologically characterized by calcification of dermal arterioles. While most lesions occur on the lower extremities followed by the lower abdomen, rare sites such as breast and penis have been reported. Herein, we present a case of penile calciphylaxis that was diagnosed clinically.
Case Description
A 34-year-old man with end-stage renal disease (ESRD) secondary to diabetes mellitus, on hemodialysis for 2 years was seen for worsening pain and blackening of the skin in the penile region that started a month ago. He denied having any fever, painful urination, discharge from the urethra or unprotected sexual intercourse in the recent past. Physical examination revealed mild edema and superficial necrosis of the foreskin and glans penis [Figure 1A]. Laboratory data demonstrated a high blood urea nitrogen of 100 mg/dL, serum creatinine 12.2 mg/dL, parathyroid hormone (PTH) 400 pg/mL and calcium-phosphorus product of 111 mg/dL. He was not on therapeutic anticoagulation and work up for hypercoagulable disorders was negative. Plain radiographs of the pelvis demonstrated widespread vascular calcification [Figure 1B], suggestive of CUA.
Discussion
High calcium-phosphate product, elevated PTH, hypoalbuminemia, diabetes, obesity, warfarin use, female sex and protein C or S deficiency are among the risk factors for CUA and skin biopsy is the gold standard of diagnosis. However, biopsy is not typically recommended for penile lesions because of the risk for progression of necrosis and therefore, penile CUA essentially remains a clinico-radiologic diagnosis. Treatment includes aggressive risk factor control, intensification of hemodialysis regimen, supportive wound care and administration of intravenous sodium thiosulfate with dialysis, all of which we instituted in our patient. The prognosis remains poor despite treatment and the main cause of mortality in these patients is sepsis.