Tumoral calcinosis without hyperparathyroidism in a patient on continuous ambulatory peritoneal dialysis

Reports of tumoral calcinosis (TC) in peritoneal dialysis (PD) patients are rare. Reported PD patients with TC also had hyperparathyroidism. A 67-year-old man on continuous ambulatory PD for almost 3 years developed TC of the right wrist and knee and both shoulders and feet. In the 2 years preceding the diagnosis of TC, this patient's serum parathyroid hormone levels were consistently low (17 +/- 12 pg/ mL). Hypercalcemia had been found in 32% of the serum samples, hyperphosphatemia in 91%, and elevated Ca x P product in 78% of the samples. At presentation with TC, serum C-reactive protein was elevated, and serum levels of vitamin D compounds were below normal. Four months after the diagnosis of TC, the patient died with a combination of gastrointestinal and retroperitoneal bleeding episodes and septic events. Tumoral calcinosis may develop in PD patients without hyperparathyroidism. Sustained hyperphosphatemia and high Ca x P product are important in the pathogenesis of uremic TC. Elevated indices of inflammation may accompany TC. Studies are needed to identify other important factors in the pathogenesis of TC in PD patients and to evaluate treatment methods.