ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO580

Isolated Penile Calciphylaxis in ESRD

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Ingram, Kelly, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
  • Thomas, Raj Jessica, Cleveland Clinic, Cleveland, Ohio, United States
  • Johnson, Nathan, Advanced Dermatology and Skin Cancer Center, PLLC, Fayetteville, Arkansas, United States
  • Grider, Douglas J., Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
Introduction

Calciphylaxis is a vascular occlusive disease associated with ESRD. The pathophysiology is not well understood, but it is considered a manifestation of severely dysregulated calcium-phosphorous metabolism. Blood vessel lumens undergo progressive medial calcification and intimal fibrosis resulting in thrombosis, ischemia, and tissue death. It commonly involves the lower extremities, but penile involvement is rare.

Case Description

A 75-year-old male presented to the ED with a 3-week history of progressive pain with focal erythematous macules/patches on the glans penis. Past medical history included ESRD with peritoneal dialysis and anuria. The rash consisted of necrotic crust at the urethral meatus (Fig. 1A) and white circinate and hemorrhagic purpuric patches on the proximal glans (Fig. 1B). Wound culture was positive, but histopathology also revealed fibrointimal hyperplasia (bracket), calcified thrombus (solid arrow), and calcification of a vessel (dotted arrow) (Fig. 2A). von Kossa staining indicated calcium deposition, confirming the diagnosis of calciphylaxis (Fig. 2B). The patient declined additional treatment and died 1 month later.

Discussion

Calciphylaxis develops rapidly and has a poor prognosis with a mortality rate of 40-80%; therefore, early diagnosis and intervention are critical. Calciphylaxis is an important differential in ESRD patients and special stains, such as the von Kossa, are essential to avoid overlooking subtle calcifications. Calciphylaxis requires a multidisciplinary approach involving nephrology, urology, surgery, and palliative care. Treatment includes sodium thiosulfate, hemodialysis, wound care, pain management, and tissue debridement or amputation.

Lab Results
TestResults (Reference Range)
Calcium7.9 mg/dL (8.5-10.7 mg/dL)
Phosphorous8.0 mg/dL (2.5-4.6 mg/dL)
BUN51 mg/dL (6-20 mg/dL)
GFR5 mL/min/1.73m2 (>60 mL/min/1.73m2)
Creatinine8.6 mg/dL (0.5-1.4 mg/dL)
PTH852.4 pg/mL (18.4-88.0 pg/mL)
Wound Culture4+ Gram Negative Rods and Gram Positive Cocci

Fig. 1

Fig. 2