Calciphylaxis mimicking ecthyma gangrenosum

Area of Science:

• Dermatology
• Nephrology
• Pathology

Background:

• Calciphylaxis is a rare, severe cutaneous disease associated with end-stage renal disease and long-term dialysis.
• It presents with painful necrotic skin lesions and carries a high mortality rate.
• Differential diagnosis can be challenging, often mimicking infectious processes like ecthyma gangrenosum or cutaneous vasculitis.

Observation:

• A case report of a patient with a 10-year history of chronic kidney disease (CKD) on dialysis.
• The patient presented with painful necrotic ulcers on the thigh.
• Tissue cultures revealed bacterial infections (Enterobacter cloacae, Citrobacter freundii, Pseudomonas aeruginosa), complicating the clinical picture.

Findings:

• Histopathological examination was diagnostic for calciphylaxis, despite positive bacterial cultures.
• This highlights the importance of histopathology in diagnosing calciphylaxis, even in the presence of concurrent infections.
• The clinical presentation and diagnostic challenges are emphasized.

Implications:

• Enhancing physician awareness of calciphylaxis in CKD patients with necrotic ulcers is critical.
• Prompt diagnosis and appropriate management can potentially reduce severe complications and improve patient prognosis.
• This case underscores the need for a high index of suspicion for calciphylaxis in dialysis patients with unexplained skin necrosis.