Calciphylaxis mimicking inflammatory breast cancer

Area of Science:

• Nephrology
• Dermatology
• Pathology

Background:

• Calciphylaxis is a rare, severe condition involving microvascular calcification and tissue necrosis.
• It often presents in patients with end-stage renal disease (ESRD) and secondary hyperparathyroidism.
• Typical symptoms include painful skin lesions with a livedo reticularis pattern.

Observation:

• A 59-year-old female patient with ESRD presented with symptoms mimicking inflammatory breast cancer.
• Initial biopsy and mastectomy revealed calciphylaxis, not malignancy.
• The patient experienced recurrent hyperparathyroidism, necessitating a re-parathyroidectomy with reimplantation.

Findings:

• This case represents the first documented instance of calciphylaxis recurrence following subtotal parathyroidectomy.
• The findings underscore the complex interplay between ESRD, hyperparathyroidism, and calciphylaxis.
• The breast pathology was ultimately attributed to calciphylaxis, despite initial suspicion of cancer.

Implications:

• Patients with ESRD and breast pathology resembling inflammation/necrosis, without malignancy, should be screened for secondary hyperparathyroidism.
• Total parathyroidectomy with reimplantation is recommended for managing recurrent hyperparathyroidism in such cases.
• Mastectomy should be reserved for persistent symptoms, necrosis, or infection unresponsive to other treatments.