Pre-uremic calciphylaxis

Calciphylaxis is characterized by calcification and thrombosis of arteries resulting in ischemic necrosis of predominantly skin and subcutaneous tissue. Primarily affecting patients with end-stage renal disease, calciphylaxis is diagnosed rarely in the absence of renal replacement therapy. We report an elderly obese woman presented with leg pain and ulceration. She had chronic kidney disease, diabetes mellitus, hypertension, and peripheral vascular disease. Angiography revealed occlusion of the left superficial femoral, popliteal, and distal tibial arteries. Amputation was performed. Histological examination demonstrated medial calcification, intimal hyperplasia, and thrombosis of small- and medium-sized arteries in the subcutaneous tissue. This case features calciphylaxis in a patient with chronic kidney disease before the onset of uremia. Calciphylaxis and atherosclerotic peripheral vascular disease have several risk factors in common. This report calls attention to a disorder that can be masqueraded as leg ulceration due to peripheral vascular disease in the absence of renal replacement therapy.