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Abstract: FR-PO552

Metastatic Calcinosis of Gastric Mucosa

Session Information

Category: Trainee Case Report

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Kosuru, Vatsalya, Augusta University Medical Center, Martinez, Georgia, United States
  • Padala, Sandeep A, Augusta University, Augusta, Georgia, United States
  • Kapoor, Rajan, Augusta University / Medical College of Georgia, Augusta, Georgia, United States
  • Gani, Imran Yaseen, SELF, Augusta, Georgia, United States
  • Ullah, Asad, Augusta University Medical Center, Martinez, Georgia, United States
Introduction

Metastatic calcinosis is a rare and serious complication of chronic renal failure. The striking feature is the calcification seen around large joints. While it mostly involves the blood vessels and dermis, it can also rarely affect the mucosal layers of the gastrointestinal tract.

Case Description

A 49-year-old African-American male with history of chronic GN leading to ESRD followed by an initial renal transplant in 1980 with subsequent graft failure in 1991, requiring re-initiation of dialysis. Had a second transplant in 2016 with stable graft function. Two years later, he started experiencing persistent worsening dysphagia and weight loss despite normal appetite. Labs and vitals were stable. He was referred for EGD, which showed extensive patchy exudates with underlying friable ulceration of upper esophagus, erythema of antrum and few nodular regions in pre-pyloric area. Duodenal Villi showed extensive whitish tips. The pathology was consistent with Candida esophagitis and Helicobacter pylori gastritis that was treated appropriately. The biopsies also revealed mucosal calcinosis in the gastric antrum and body, which could be explained by the long-standing history of dialysis and could also be supported by the evidence of extensive calcification of common iliac and external iliac arteries, bilateral native kidneys and prior transplanted kidney. The symptoms improved with the treatment of Candida esophagitis and H. pylori gastritis.

Discussion

Metastatic calcinosis is a severe consequence of chronic renal failure, as there is a disruption in calcium and phosphorus metabolism. Failure of management of hyperphosphatemia in chronic renal failure leads to secondary hyperparathyroidism and precipitation of calcium products in multiple organs. Though Calcinosis of vascular media is the common finding, it can rarely involve the mucosal layers of the GI tract causing ulcerations.

Pre pylorus and Antrum