Pre-uremic calciphylaxis.

Area of Science:

• Vascular Medicine
• Nephrology
• Dermatology

Background:

• Calciphylaxis is a rare, severe condition involving arterial calcification and thrombosis, leading to tissue necrosis.
• It predominantly affects patients with end-stage renal disease (ESRD) on dialysis.
• Diagnosis in the absence of renal replacement therapy is uncommon.

Observation:

• An elderly, obese woman with chronic kidney disease (CKD), diabetes, hypertension, and peripheral vascular disease presented with leg pain and ulceration.
• Angiography showed severe arterial occlusions in the leg, necessitating amputation.
• Histopathology confirmed calciphylaxis with medial calcification, intimal hyperplasia, and thrombosis in small and medium subcutaneous arteries.

Findings:

• This case demonstrates calciphylaxis in a patient with CKD prior to developing uremia.
• The patient's presentation mimicked advanced atherosclerotic peripheral vascular disease.
• Shared risk factors exist between calciphylaxis and atherosclerotic peripheral vascular disease.

Implications:

• This case underscores the importance of considering calciphylaxis in patients with CKD and leg ulcerations, even without ESRD.
• Early recognition is crucial for appropriate management and potentially preventing severe outcomes.
• Differentiating calciphylaxis from peripheral vascular disease is critical for accurate diagnosis and treatment.