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Abstract: FR-PO550

The Heart of Calcium

Session Information

Category: Trainee Case Report

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Acharya, Prakrati C., University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Kovvuru, Karthik, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Vaitla, Pradeep, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Kanduri, Swetha Rani, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
Introduction

Calciphylaxis or calcific uremic arteriopathy is a rare disorder causing diffuse calcification of arterioles in dermis and subcutaneous tissue. We here by present a case of systemic calciphylaxis presenting as non infective endocarditis with stroke.

Case Description

59 year old Caucasian female with End stage Renal disease secondary to Microscopic polyangitis (with only renal involvement +PANCA) for 2 years initially on hemodialysis for a year and then switched to peritoneal dialysis, presented to the hospital with subjective fever and shortness of breath concerning for multifocal pneumonia. Echo showed 1.5 x 2 cm mitral valve vegetation and PFO. Her infectious work up was persistently negative including blood cultures for bacterial, fungus and AFB. She did not have fever during hospitalization. Hospital course was complicated by stroke thought to be embolic from valve vegetation. With worsening clinical conditions she underwent mitral valve replacement and mitral valve pathology showed myxoid degeneration, with no inflammation or organism but calcification and cultures remained negative.
On presentation patient also complained of painful hard nodules from ankle to knee of posterior bilateral lower extremities for 6 months. Biopsy was diagnostic for calciphylaxis. She had elevated phosphorus to 11 and PTH of 780 on presentation The mobile masses seen on echocardiography were likely to represent healed vegetations that had calcified as a result of calciphylaxis. She was started on intensive daily dialysis and sodium Thiosulfate with good outcome.

Discussion

High clinical suspicion is warranted to make the diagnosis of calciphylaxis. Despite a multi-interventional approach for calciphylaxis, the disease remains associated with a high morbidity and mortality. To our knowledge this is the first reported case of non infective endocarditis with complication of stroke as the initial manifestation of calciphylaxis followed by further work up showing skin involvement, with ultimate good outcome.