Calciphylaxis of the penis and distal digits: a case report

Abstract

Background Calciphylaxis is a rare, often fatal disease resulting from calcification of dermal arterioles and capillaries. Usually diagnosed in patients with end-stage renal disease, this disorder typically presents as necrotic, nonhealing ulcers in acral or adipose areas. Here we report the case of an elderly man who was found to have calciphylaxis of the distal digits and penis, the latter of which is an uncommon site of disease that carries a particularly poor prognosis. Case presentation A 73-year-old African American man with multiple medical comorbidities including dialysis-dependent end-stage renal disease presented with worsening painful, necrotic lesions on his glans penis and several distal digits over the last 2 months. The wound on the glans was foul smelling with overlying purulence and had been unsuccessfully treated with amoxicillin–clavulanic acid. Discovery of diffuse intravascular calcification on computed tomography, in addition to a markedly elevated calcium–phosphate product immediately prior to the onset of his ulcers, led to the diagnosis of calciphylaxis. The patient was initiated on sodium thiosulfate without improvement in his lesions, and he died 3 months later after another prolonged hospitalization. Conclusions While calciphylaxis is a rare disease, involvement of the distal digits and especially the penis is even more uncommon and portends a particularly poor prognosis: 6-month mortality rates are reportedly as high as 70%. This suggests that prompt recognition and management of the disease is required; however, despite receiving standard therapy, our patient failed to experience improvement in his disease and instead developed several more fingertip ulcers at blood glucose sample points during his hospitalization. A corollary of the case presented here is the need for more effective management of calciphylaxis, especially for patients in whom uncommon sites, such as the penis, are involved.

Calciphylaxis and Kidney Disease: A Review

“…While most commonly seen on the abdomen and proximal lower extremities, calciphylaxis has been reported in relatively uncommon sites including the penis, breasts, and digits. [26][27][28][29][30] The presence of ulceration is associated with an increased mortality rate (Figure 3). 31 Visceral calciphylaxis without primary cutaneous manifestations has also been reported, such as in mesenteric and colonic arteries .…”

Anti-racist strategies for clinical and translational research: Design, implementation, and lessons learned from a new course

“…One case report noted the subject's race, without further comment. 44 The case series described a rare genetic disease using the term origin, reflecting geography or ethnicity 46 . One letter was a secondary analysis of a prospective cohort study that collected race/ethnicity data as "white" and "non-white"; it noted overrepresentation of high-income families as a limitation to generalizability 47 .…”

“…Ten were published by a student with a faculty appointment [34][35][36][37][38][39][40][41][42][43]. Overall, there were 3 case reports [34,44,45], one case series [46], 2 editorials [41,43], 2 letters [37,47], 2 review articles [48,49], 7 systematic reviews [35,36,[38][39][40]42,50], 2 retrospective cohort studies [51,52], an evaluation of mobile health applications [53], and a medical education report. [54] One case report noted the subject's race, without further comment [44].…”

“…Overall, there were 3 case reports [34,44,45], one case series [46], 2 editorials [41,43], 2 letters [37,47], 2 review articles [48,49], 7 systematic reviews [35,36,[38][39][40]42,50], 2 retrospective cohort studies [51,52], an evaluation of mobile health applications [53], and a medical education report. [54] One case report noted the subject's race, without further comment [44]. The case series described a rare genetic disease using the term origin, reflecting geography or ethnicity [46].…”

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“…Painful evolving skin lesions (livedo reticularis, livedo racemosa, and retiform purpura) typically involving the areas of cutaneous and subcutaneous adiposity and rapidly progressing to ulcers with black eschar are the hallmarks of calciphylaxis presentation [9]. Although reported in relatively uncommon sites, including the penis, the digits, and the breasts [10][11][12][13], the lesions are most commonly seen on the abdomen and proximal lower extremities.…”