Cutaneous gangrene, metastatic calcification and secondary hyperparathyroidism

Abstract

A case of cutaneous gangrene in association with secondary hyperparathyroidism is described. Histology of a skin ulcer showed medial calcification of small blood vessels with superimposed thrombosis. The patient's skin lesions have not recurred after medical therapy and para thyroidectomy .A 60-year-old woman presented in December 1988 with a 3-month history of tender purpuric nodules 3-5 cm in diameter on her buttocks, thighs and lower legs: these lesions were surrounded by broken livido and subsequently ulcerated. She had suffered from ulcerative colitis and underwent a pan-proctocolectomy with ileostomy in 1970 followed by five further laparotomies for small bowel obstruction due to adhesions, with bowel resection performed each time. Since 1979, she had had a high ileostomy output of 2-3 I/day. Current investigations showed a normochromic, normocytic anaemia (6.8 g/dl), raised ESR ( > 144 mm/h), C-reactive protein (1 7.7 mg/l, normal < 10) and a,-acid glycoprotein (2.3 5 g/l, normal < 1.2), and normal clotting and autoantibody studies.The skin lesions were biopsied and histological examination showed ulceration and marked medial calcification of numerous blood vessels in the deep dermis and subcutaneous tissue, with organizing thrombus. No evidence of a pre-existing or active vasculitis was seen (Figure 1). A diagnosis of metastatic calcification, thrombosis and cutaneous gangrene was made and

Calciphylaxis with Peau D'Orange Induration and Absence of Classical Features of Purpura, Livedo Reticularis and Ulcers

“…A promising premise is that anticoagulation would prevent or reduce secondary lesions of infarction (4,36). This has been supported by some cases using both warfarin and heparin in the effective treatment of calciphylaxis; but there are studies with warfarin that have been equivocal (5, 6, 20, 43). Additional factors may affect and compromise local blood flow such as hypotension and shock (36, 38, 44).…”