Gastrointestinal calciphylaxis: a rare and devastating complication in end-stage kidney disease

Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare and severe condition that predominantly affects individuals with end-stage kidney disease (ESKD). It manifests through vascular calcifications that precipitate tissue necrosis, with cutaneous manifestations being common. However, gastrointestinal involvement is an infrequent but gravely serious occurrence. In this report, we present an atypical case of gastrointestinal (GI) calciphylaxis in a 66-year-old woman undergoing peritoneal dialysis. The patient's initial symptoms of abdominal pain and turbid peritoneal fluid raised suspicions of bacterial peritonitis. Despite therapeutic interventions, the patient's condition deteriorated. Computed tomography (CT) imaging revealed a perforation in the caecal wall, necessitating emergency surgical intervention. Histopathology post-surgery confirmed the diagnosis of GI calciphylaxis. The patient's postoperative trajectory was fraught with complications, ultimately leading to a fatal outcome. This case highlights the importance of vigilance for calciphylaxis in the differential diagnosis when abdominal pain develops in patients with ESKD, regardless of the presence of typical skin symptoms. Prompt detection and an integrated care approach are essential for improved prognosis. Further research is needed to find more efficacious treatments for this devastating illness.