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Calciphylaxis with evidence of hypercoagulability successfully treated with unfractionated heparin: a
A Carter1, A G Ortega-Loayza2, J Barrett3
1Department of Dermatology, New York Medical College, New York, NY, USA.
Insights
Calciphylaxis, a condition causing abnormal blood vessel and skin calcification, has unclear causes. This case highlights that treating calciphylaxis may benefit from exploring hypercoagulable states and considering anticoagulation therapy.
Area of Science:
- Vascular Biology
- Dermatology
- Nephrology
Background:
- Calciphylaxis involves abnormal calcification of blood vessels and skin, with unclear etiology and pathogenesis.
- Frequently associated conditions include end-stage renal disease, diabetes mellitus, and hyperparathyroidism.
- Skin lesions can be sudden, rapidly progressing, and are most common on the legs.
Abstract:
Calciphylaxis is characterized by abnormal calcification of vessels and skin; however, its aetiology and pathogenesis remain unclear. Entities frequently associated with calciphylaxis are end-stage renal disease, diabetes mellitus, hypercalcaemia, hyperphosphataemia, elevated calcium-phosphate product, hyperparathyroidism and possible hypercoagulable states. Skin lesions may remain quiescent or may develop suddenly and progress rapidly. They are more common on the legs. Treatment of calciphylaxis is very challenging and requires interdisciplinary management. We present a case that highlights the difficulty of treating calciphylaxis. A multidisciplinary approach was vital for the proper treatment of our patient. This case also demonstrates the importance of searching for underlying hypercoagulable states, especially in recalcitrant cases. In cases of calciphylaxis with vessel occlusion from microthrombi, heparin therapy would be a logical next step. The effect of anticoagulation may be rapid and impressive.
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