Abdominal catastrophe in a 43-year-old female with end stage renal disease

A 43-year-old female with end-stage renal disease secondary to focal segmental glomerulosclerosis was admitted to the hospital for shortness of breath after missing hemodialysis. On admission, the patient was noted to have painful skin lesions consistent with calciphylaxis on biopsy. While undergoing aggressive wound care, she developed altered mental status and was found to be septic and started empirically on broad-spectrum antibiotics. The patient was intubated on day 4 of admission owing to worsening mental status and acidemia. She had persistent positive blood cultures throughout her hospitalization despite appropriate antibiotic therapy. On day 25 of admission, the patient was found to have abdominal distension. A radiograph revealed intra-abdominal free air, and the patient was taken to the operating room where she was found to have perforated necrotic bowel. The patient expired on day 26 of admission. An autopsy revealed calciphylaxis within the gut wall and within the dura of the central nervous system. While typically a disorder of subcutaneous tissue, calciphylaxis can affect internal organs, which in this case resulted in a catastrophic outcome.