Nonuremic calciphylaxis in a COVID‐19 patient

Mathur, N K; Duffy, Robert; Chinn, Brandyn; McFarland, Miles M.; Gable, Brian; Clay, Christina M.; Heymann, Warren R.

doi:10.1111/ijd.15661

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…Previous reports of uremic-associated disease describe its development within a month following COVID-19 diagnosis. 5,11,13 In our case, the manifestations of calciphylaxis began much later, presenting 3 months after infection and 2 months after recovery of renal function and discontinuation of warfarin.…”

Section: Discussionmentioning

confidence: 61%

“…To the authors' knowledge, this is only the second reported case of non-uremic calciphylaxis following COVID-19. 5 The pathogenesis of calciphylaxis is thought to be multifactorial, involving an imbalance of calcium and phosphate levels that results in the formation and deposition of calciumphosphate crystals contributing to chronically narrowed vessels. 2 Traditionally, calciphylaxis occurs in the setting of renal failure, which disrupts the normal concentrations of these electrolytes due to decreased renal phosphate excretion and secondary hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,6 Prothrombotic states are also implicated. 1,5,7,8 Warfarin use is associated with as much as a 13-fold increased risk of calciphylaxis. As a vitamin K antagonist, warfarin is thought to predispose to calciphylaxis through a reduction in levels of matrix-gla protein, an inhibitor of microvascular calcification whose carboxylation is vitamin Kdependent.…”

Section: Discussionmentioning

confidence: 99%

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Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury – A report of a case

Halle,

Ishii,

P. Zwerner

et al. 2022

AJHM

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Herein we report a case of an obese female presenting with calciphylaxis after a prolonged hospital course due to COVID-19, with multiple complications including now-recovered acute renal failure and deep venous thrombosis requiring treatment with warfarin. Two months after discharge, she presented with new, painful, ulcerated plaques on the thighs and was diagnosed with calciphylaxis. Throughout the COVID-19 pandemic, cutaneous manifestations of SARS-CoV-2 infection have been increasingly characterized, yet non-uremic calciphylaxis is infrequently observed. Despite its rarity, our case highlights the importance of clinician awareness of the potential association of COVID-19 as an additional trigger for calciphylaxis, especially in patients with multiple risk factors. We also urge physicians to be aware of delayed onset in the presentation of calciphylaxis after renal recovery.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury – A report of a case

Halle,

Ishii,

P. Zwerner

et al. 2022

AJHM

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“… 7 The mechanism of calciphylaxis in COVID-19 infection remains unconfirmed, but one hypothesis could be related to platelet aggregation and persistent complement activation leading to vasculopathy. 8 A prothrombotic state, as seen in COVID-19, has been hypothesized to be necessary to create the opportunity for calciphylaxis in conjunction with a hyperinflammatory state. 5 , 9 However, mechanisms for calcium deposition can only be speculative to date and may more likely be a combination of vasculopathy, hypercoagulopathy, and calcium deposition due to multifactorial effects that include key factors, such as nuclear factor κ-B, endothelin-1, and other cytokines influenced by this hyperinflammatory MIS-C state, in addition to other previously identified etiologic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis in a pediatric patient with multisystem inflammatory syndrome

Distel¹,

Purohit²,

Ingraham³

et al. 2023

JAAD Case Reports

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“…This hypercoagulable state may increase the risk of more common thrombotic complications, including pulmonary embolism, myocardial infarction, and stroke [6]. Cases of a more rare complication, NUC, have also been reported in the setting of COVID-19 [9][10][11]. Current literature suggests a "two-hit" mechanism wherein a patient may have an asymptomatic or subclinical hypercoagulable condition that, when combined with a prothrombotic state in the setting of severe COVID-19 infection, predisposes patients to rare complications such as calciphylaxis [9,10].…”

Section: Discussionmentioning

confidence: 99%

Nonuremic Calciphylaxis Precipitated by COVID-19 Infection

Shuman¹,

Obri²,

Artz³

et al. 2022

Cureus

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Calciphylaxis is a rare dermatologic condition that is primarily associated with end-stage renal disease (ESRD). Nonuremic calciphylaxis has been reported in patients with autoimmune disorders such as systemic lupus erythematosus and other hypercoagulable states such as anti-phospholipid syndrome. New research throughout the COVID-19 pandemic has shown an increased inflammatory and coagulopathic complication of COVID-19. We present a case of a patient with nonuremic calciphylaxis following treatment for severe COVID-19 and no known cause of hypercoagulability.A 40-year-old Caucasian female with a history of recent COVID-19 infection requiring hospitalization, hypertension, alcohol abuse, anxiety, and one prior spontaneous miscarriage presented to the hospital with bilateral lower extremity wounds. The wounds were seen to have necrosis and eschar formation, as well as blackened mottled skin, and were extremely painful to the patient. The initial lesions were on the anterior thighs bilaterally and spread laterally and to the lower back. Initial autoimmune workup was non-specific, and biopsy confirmed calciphylaxis.Calciphylaxis is a known dermatologic disease that has high mortality and morbidity, but it is usually associated with ESRD. Some cases have been reported for autoimmune or hypercoagulable states. The disease presents with non-healing, painful skin ulcers that are at a high risk of infection and have poor healing. The case presented shows biopsy-confirmed calciphylaxis in the absence of known etiologies, and we hypothesize that it is due to COVID-19 or COVID-19 aggravating an underlying but unidentified hypercoagulable condition.

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Nonuremic calciphylaxis in a COVID‐19 patient

Cited by 3 publications

References 7 publications

Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury – A report of a case

Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury – A report of a case

Calciphylaxis in a pediatric patient with multisystem inflammatory syndrome

Nonuremic Calciphylaxis Precipitated by COVID-19 Infection

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