Successful Treatment of Calciphylaxis in a Young Female With End-Stage Renal Disease on Peritoneal Dialysis With Parathyroidectomy, Intensification of Dialysis, and Sodium Thiosulphate—A Case Report and Literature Review

Abstract

Calcific uremic arteriolopathy, commonly referred to as “calciphylaxis,” is a rare life-threatening condition observed in patients with chronic kidney disease and end-stage renal disease on dialysis. This results in necrotic, ischemic, tender dermal lesions anywhere in the body, but mainly on the abdominal wall and lower extremities, where subcutaneous tissue is abundant. Histologically, it is defined by calcification in dermal capillaries, arterioles, and subcutaneous adipose tissues. It can occur in all advanced stages of chronic kidney disease as well as end-stage renal disease patients on hemodialysis or peritoneal dialysis. Our case highlights a successful case of calciphylaxis in a young female patient who underwent parathyroidectomy and intensification of peritoneal dialysis regimen along with the infusion of sodium thiosulphate injection resulting in complete resolution of the lesion in 3 months. With limited evidence of treatment options and increased frequency of this condition in a dialysis patient, our case highlights the key aspects of calciphylaxis management in a young end-stage renal disease patient who didn’t need a change of dialysis modality. We also review the risk factors and current practiced management options of this condition in our article.

Calciphylaxis: A Rare Clinical Presentation in a Patient with End-Stage Renal Disease (ESRD)

“…Treatment of the underlying condition is key as the prognosis is poor, even with specific medications. Treatment guidelines include an increase in the frequency of dialysis in patients with ESRD, adequate wound care, topical antibacterial, use of thrombolytic agents, hyperbaric oxygen, and sodium thiosulfate are frequently employed [13,[22][23][24][25]. Non-orthodox treatment options, like maggot larval debridement for extensive ulcerations and plasma exchange, have also been employed [14,23,25].…”

“…Treatment guidelines include an increase in the frequency of dialysis in patients with ESRD, adequate wound care, topical antibacterial, use of thrombolytic agents, hyperbaric oxygen, and sodium thiosulfate are frequently employed [13,[22][23][24][25]. Non-orthodox treatment options, like maggot larval debridement for extensive ulcerations and plasma exchange, have also been employed [14,23,25]. A multidisciplinary approach to intervention comprising optimum nursing care, a dermatologist, plastic surgeon, nephrologist, dietician, wound care specialist internist, and a psychologist are required [8].…”

Calciphylaxis: A Rare Complication With a Fatal Outcome in End-Stage Renal Disease

“…On histology, it is characterized by calcium deposition on the medial layer of vessel walls and hyperplasia or fibrosis of the intima, in addition to thrombosis of small vessels [ 10 ]. The risk factors for calciphylaxis that our patient possessed included female sex, diabetes mellitus, hypoalbuminemia, warfarin usage, hyperphosphatemia, obesity, and length of dialysis [ 5 ]. Differential diagnoses for a skin lesion appearing on a hemodialyzed patient include but are not limited to, calciphylaxis, WISN, heparin-induced thrombocytopenia, necrotizing fasciitis, cellulitis, and ecthyma [ 7 ].…”

“…Calciphylaxis is characterized by the obstruction of small vessels due to calcification in the subcutaneous fat and dermis, which results in extremely painful skin lesions [ 4 , 5 ]. Skin lesions may first manifest as plaques, nodules, and indurations, eventually evolving to ulcers with a stellate shape and black eschars [ 4 , 5 ]. It usually occurs in the abdomen and the lower extremities [ 5 ].…”

“…Skin lesions may first manifest as plaques, nodules, and indurations, eventually evolving to ulcers with a stellate shape and black eschars [ 4 , 5 ]. It usually occurs in the abdomen and the lower extremities [ 5 ]. Calciphylaxis, which carries a high one-year mortality rate of over 50%, is often complicated by infection of the underlying skin lesion, leading to sepsis [ 6 ].…”