Digital calciphylaxis progressing to amputation in a child on continuous ambulatory peritoneal dialysis

Area of Science:

• Nephrology
• Dermatology
• Vascular Biology

Background:

• Calciphylaxis is a rare, severe condition characterized by medial calcification of small arterioles, leading to progressive cutaneous necrosis.
• It is most commonly observed in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism.

Observation:

• This report describes an 11-year-old female patient experiencing end-stage renal failure (ESRF).
• The patient presented with calciphylaxis affecting the toes, a critical manifestation of the disease.

Findings:

• The patient's calciphylaxis was refractory to medical management.
• Surgical intervention in the form of amputation was ultimately required due to the severity and non-responsiveness of the condition.

Implications:

• This case highlights the challenges in managing calciphylaxis, particularly in pediatric ESRD patients.
• It underscores the potential need for aggressive treatment strategies, including amputation, when medical therapies fail to resolve severe cutaneous manifestations.