Gastrointestinal Bleeding Secondary to Calciphylaxis

Abstract

Patient: Female, 66Final Diagnosis: CalciphylaxisSymptoms: Gastrointesinal haemorrhageMedication: NoneClinical Procedure: Hemodialysis • blood transfusionsSpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa.Case Report:A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed.Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure.Conclusions:Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding.

Systematic review of sodium thiosulfate in treating calciphylaxis in chronic kidney disease patients

“…A total of 83 papers were screened independently by TP and DH. Forty‐five studies including 358 patients met the inclusion criteria . These included 36 case reports and nine multi‐case reports.…”

“…These included 36 case reports and nine multi‐case reports. Twelve studies were published in the abstract form only . None of them was a randomized controlled trial.…”

Isolated Mesenteric Calciphylaxis With Ischemic Colitis in a Hemodialysis Patient Without Active Cutaneous Calciphylaxis: A Case Report of Calcific Uremic Arteriolopathy

“…This challenges the concept that CUA is a disorder of cutaneous microvascular occlusion. Of the 8 reported cases of biopsy-proven mesenteric calciphylaxis in the dialysis population in the English literature, 1 , 7 , 8 , 9 , 10 , 11 , 12 7 patients were female. Half the cases had chronic kidney failure due to diabetes, with the mean age of 54 years.…”

“… 5 There are reports of visceral calciphylaxis occurring in patients with active cutaneous lesions, and these have all been fatal. 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 We present a hemodialysis patient presenting with mesenteric calciphylaxis without active cutaneous disease.…”

Rare Case of Hematemesis: Calciphylaxis of the Esophagus

“…She had rectal mucosal edema, diffuse ulcer formation, bowel perforation from a bowel infarction, and ultimately died. 2…”