Images – Penile pain in the setting of end-stage renal disease: An unusual anatomic location for calciphylaxis

Abstract

In this report, we present a case of penile calciphylaxis, an extremely rare and serious condition occurring in association with dysregulation of systemic calcium metabolism in the setting of chronic renal impairment. Calciphylaxis can occur at various body sites and is associated with diffuse vascular calcifications in small and medium-sized arteries of the involved tissues. Penile calciphylaxis has a grim prognosis. Calciphylaxis is an important etiologic differential diagnosis for penile necrosis and penile pain in patient’s being treated with dialysis for end-stage kidney disease. Diagnosis of penile calciphylaxis is possible via clinical and radiological evaluations. Medical management may alleviate symptoms; however surgical interventions may be necessary, and histological studies may allow for definitive classification.

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 .…”

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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.…”

"Exploring Novel Therapeutic Strategies for Calciphylaxis: A Focus on Vitamin K2 Supplementation"

“…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.…”