Abstract: FR-PO636
A Case Report of Early Calciphylaxis Based on Single Cutaneous Erythema and Literature Review
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
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Liu, Yuqiu, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
- Ni, Haifeng, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
- Zhang, Xiaoliang, Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
Introduction
We analyzed the clinical information of a patient with single cutaneous erythema leading to calciphylaxis, and reviewed literatures. Improve clinical understanding of calciphylaxis to reduce the occurrence of missed diagnosis and misdiagnosis.
Case Description
A 36-year-old male patient with hemodialysis for 5 years had focal purple-black skin changes in the left leg recently（Fig.A）. Then the wound was enlarged and ulcerated with mild pain（Fig.B）. X-rays showed the large vessel calcification（Fig.D）. There was multiple subcutaneous small vessel calcification by further plain CT scanning of suspicious vessel calcification area. In particular, small blood vessels deep in the skin lesions were significantly calcified（Fig.E）. Imaging evidence strongly suggests a diagnosis of calciphylaxis. A skin biopsy was performed on the rough skin of the patient's left lower leg. The pathology showed extensive calcium deposits in the subcutaneous soft tissue with calcification of the small vessel wall（Fig.F）. The calciphylaxis was diagnosed and was still in the early stage of disease. After comprehensive treatment based on sodium thiosulfate for three months, the necrosis area was gradually scabbed and the wound healed（Fig.C）.
Discussion
Calciphylaxis is a fatal vascular disease characterized by systemic arteriole calcification with endothelial destruction and thrombosis, resulting in peripheral tissue ischemic necrosis. This patient presented with a single, early-onset skin lesion and lacked typical skin lesions. Imaging examinations have a high guiding significance in the diagnosis of calciphylaxis in this case. Recently, the prevalence of calciphylaxis in dialysis patients has been increasing, and a combination of diagnostic techniques has helped early detection. Skin biopsy helps diagnose early and atypical patients, while imaging is a non-invasive test that can be used as an early screening and efficacy monitoring tool.