Calciphylaxis in a Dialysis Patient Diagnosed by Muscle Biopsy

Abstract

Calciphylaxis is a rare condition seen mostly in patients with chronic renal disease and secondary hyperparathyroidism who develop painful skin lesions and myopathy secondary to extensive small vessel calcification, which leads to tissue ischemia. It is typically diagnosed by a biopsy of prominent skin lesions. Here, we report a 49-year-old man with end-stage renal disease on chronic peritoneal dialysis who presented with weakness, myalgias, and necrotic skin lesions. Multiple skin biopsies were nondiagnostic because of severe extensive necrosis, and the diagnosis of systemic calciphylaxis was eventually made by a muscle biopsy. This case demonstrates the significant muscle involvement in calciphylaxis and highlights the importance of maintaining a high clinical suspicion for patients with risk factors for calciphylaxis, even when skin biopsy does not confirm it.

A case report of pediatric calciphylaxis–a rare and potentially fatal under diagnosed condition

“…Apart from cutaneous manifestations, vascular calcifications in the skeletal muscle, brain, lungs, intestine, eyes, and mesentery have been reported. [ 13 – 19 ] In most cases, calcifications affect the middle layer of the arterial vessels, but damage to the intima has also been reported. [ 20 , 18 ] Our case presented an unusual, diffuse, and extensive calcifying uremic arteriolopathy syndrome with diffuse calcifications in the dermis, brain, thymus, heart, lung, kidney, stomach, and pancreas.…”

Generalized Weakness in a Transplant Patient: A Case Presentation

“…When manifesting as skin necrosis and painful nonhealing ulcers, it resembles vasculitis [3]. The etiology is unknown but hypothesized due to prior sensitization with challengers such as parathyroid hormone and vitamin D analogues and decreased oxygen tension at the site of the lesions [6]. The diagnosis is often made by histologic examination of the affected skin, which shows medial calcification and intimal proliferation of cutaneous arterioles [1‐3].…”

Advanced-stage calciphylaxis: Think before you punch

“…[7][8][9] Since extensive necrosis predisposes to a negative biopsy, a high clinical suspicion should drive early treatment of calciphylaxis. 10 Noninvasive imaging studies such as plain radiography and bone scintigraphy can aid the diagnosis by detecting moderate to severe soft-tissue vascular calcifi cation in these areas. [7][8][9][10][11] ■ DEBRIDEMENT IS CONTROVERSIAL Conservative measures are the mainstay of care and include dietary alterations, noncalcium and nonaluminum phosphate binders, and low-calcium bath dialysis.…”

“…10 Noninvasive imaging studies such as plain radiography and bone scintigraphy can aid the diagnosis by detecting moderate to severe soft-tissue vascular calcifi cation in these areas. [7][8][9][10][11] ■ DEBRIDEMENT IS CONTROVERSIAL Conservative measures are the mainstay of care and include dietary alterations, noncalcium and nonaluminum phosphate binders, and low-calcium bath dialysis. There is mounting evidence for the use of calcimimetics and sodium thiosulfate.…”