Abstract: SA-PO338
Improvement of Calcinosis Cutis With Sodium Thiosulfate Infusion in a Peritoneal Dialysis Patient
Session Information
- Hemodialysis and Frequent Dialysis: Potpourri
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hansrivijit, Panupong, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Iyer, Viswanathan S., UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, United States
Introduction
Calcinosis cutis, defined by calcifications of the skin, and soft tissue is a rare disease. One subtype, calciphylaxis, defined as calcified blood vessels, can be mostly seen in hemodialysis patients. However, subcutaneous calcification form is extremely rare especially in peritoneal dialysis (PD) and the treatment is unknown.
Case Description
A 49-year-old Caucasian female with end-stage kidney disease from membranous nephropathy on PD for 3 years was evaluated in clinic for chronic bilateral leg pain. Her past medical history included essential hypertension, and history of right chronic deep vein thrombosis in 2009 with resolution of thrombosis from a repeated venous Doppler ultrasound 2 years prior to current presentation. Physical examination is remarkable for lumpy nodular swelling in circumferential pattern with local tenderness in both legs, right more than left. Serum creatinine 6.3 mg/dL, blood urea nitrogen 52 mg/dL, calcium 9.3 mg/dL, phosphorus 5.5 mg/dL, CaP product 51.2 mg2/dL2, parathyroid hormone 772 pg/mL. Radiographic imaging of both legs shown in Figure 1A. A diagnosis of calcinosis cutis was made. She was started on sodium thiosulphate infusion 12.5 g three times weekly for 5 months then 25 g weekly as well as cinacalcet and sevelamer. Eight months after treatment, patient reported significant improvement in pain and radiological findings (Figure 1B). Patient tolerated treatment well.
Discussion
This case provided some key learning points. First, calcinosis cutis without calciphylaxis in this patient is unusual especially with PD and normal CaP product. Second, sodium thiosulfate might be helpful in treatment of extra-vascular calcification. However, the efficacy, dosage and duration of treatment require further investigation.
Figure 1. A) extensive bilateral subcutaneous lower leg calcifications from mid tibia to ankle, with absence of vascular calcifications; B) near resolution of calcifications on the left side, and improved calcification density on the right side.