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Abstract: PO0565

Severe Tumoral Calcinosis of the Hip in a Hemodialysis Patient

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Da Silva Lugo, Ian J., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Santiago-Gonzalez, Juan Carlos, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Ocasio Feliciano, Edilberto Jose, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Pico-Ramirez, Alexandra C., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rodriguez, Yamiris, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Andujar, Krystahl Z., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Ocasio Melendez, Ileana E., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
Introduction

Tumoral calcinosis (TC) is a rare complication of patients with end-stage renal disease (ESRD) on hemodialysis (HD) in which precipitation of calcium salts occurs in periarticular soft tissue. This manifestation can lead to painful and function restricting lesions. We herein describe a case of a severe presentation of TC with associated ulceration.

Case Description

A 47-year-old female with medical history of arterial hypertension, heart failure, hypothyroidism, focal segmental glomerulosclerosis and ESRD on HD for 15 years presented to the emergency department after a right hip ulceration. The patient described a right hip hard mass with ten years of progressive growth that suffered a sudden rupture associated with sand-like secretions. Medication and dialysis compliance was reported. Vital signs were unremarkable. Physical examination showed a right hip swelling and ulcer. Laboratories revealed WBC of 19.98 103/µL, Hgb of 8.70 g/dL, calcium 9.9 mg/dL, phosphorus 6.6 mg/dL, 25-hydroxyvitamin D 12.72 ng/mL and PTH 288.90 pg/mL. Calcium Phosphate Product (CPP) resulted in 65.34 mg/dL. Pelvic CT scan showed a 11.4cm x 9.6cm mixed density calcified cystic mass with multiple fluid-calcium levels in the right hip, suggestive of TC. Treatment with intravenous Sodium Thiosulfate, Sevelamer and antibiotics were provided. Cleansing and debridement were performed by the plastic surgery team without complications. Patient was discharged and sodium thiosulfate treatment was continued at the hemodialysis center.

Discussion

TC is associated with the dysregulation of calcium phosphate metabolism. Altered renal phosphate excretion along with vitamin D activation leading to hyperparathyroidism with elevated CPP is the proposed mechanism. The precipitation of large periarticular deposits of calcium salts leads to inflammation and chronic pain. Consequently, limiting functionality and impairing quality of life. Surgical excision can relieve symptoms, but the deposits can recur. Sodium thiosulfate has been described as a potential treatment, but further studies are necessary to assess its role in dialysis patients. The recognition of this rare disease is important as optimization of medical therapy and dialysis regimen can improve the evolution and outcome of this disorder.