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Area of Science:

  • Nephrology
  • Vascular Biology
  • Gastroenterology

Background:

  • Calciphylaxis is a rare but devastating complication of end-stage renal disease (ESRD) with high mortality.
  • Diagnosis typically relies on characteristic skin lesions, but visceral involvement, particularly gastrointestinal (GI) manifestations, is uncommon.

Observation:

  • A 66-year-old female on hemodialysis (HD) with diabetes, hypertension, and ovarian cancer presented with necrotic skin lesions and extensive arterial calcification.
  • She developed severe lower GI bleeding, confirmed by CT scan showing widespread abdominal arterial calcification and colonoscopy revealing rectal necrosis.

Findings:

  • This case demonstrates calciphylaxis presenting as lower GI bleeding and rectal ulceration, a rare manifestation of the disease.
  • Despite conservative management, including adjusting HD parameters and initiating sodium thiosulphate, the patient's condition deteriorated.
  • The patient ultimately died from multiorgan failure, underscoring the severity of visceral calciphylaxis.

Implications:

  • Calciphylaxis should be considered in the differential diagnosis for ESRD patients on HD presenting with abdominal pain or GI bleeding.
  • Early recognition and management of visceral calciphylaxis are crucial, although treatment options remain limited and outcomes are often poor.