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Calciphylaxis: Beating the Odds

José Mário Bastos1, Joana Medeiros1, Johanna Viana1

  • 1Nephrology, Unidade Local de Saúde de Braga, Braga, PRT.

Cureus
|February 6, 2025
PubMed

Insights

Calciphylaxis, a rare vascular condition causing skin necrosis, requires intensive treatment. A multidisciplinary approach including sodium thiosulfate led to complete healing in a long-term dialysis patient.

Area of Science:

  • Nephrology
  • Dermatology
  • Vascular Medicine

Background:

  • Calciphylaxis is a severe obliterative vasculopathy causing painful skin necrosis.
  • It presents a significant therapeutic challenge with poor prognoses, especially in patients with end-stage renal disease.
  • Management often involves addressing mineral and bone disorders and wound care.

Observation:

  • A 59-year-old male on renal replacement therapy for 28 years presented with a rapidly progressing necrotic leg ulcer.
  • Skin biopsy confirmed calciphylaxis.
  • The ulcer caused significant pain and functional impairment.

Findings:

  • A comprehensive treatment strategy was implemented, including intensified hemodialysis, optimized mineral and bone disorder management, and treatment of secondary infection.
  • Intravenous sodium thiosulfate infusion, surgical debridement, and skin grafting were key components of the intervention.
  • Complete wound healing was achieved within three months of initiating this intensive, multidisciplinary care plan.

Implications:

  • This case underscores the critical role of early diagnosis and a multidisciplinary approach in managing calciphylaxis.
  • Aggressive and tailored treatment can lead to favorable outcomes even in severe cases of calciphylaxis.
  • Effective management of calciphylaxis requires coordinated efforts across nephrology, dermatology, and surgical specialties.

Keywords:
calciphylaxischronic kidney diseasehemodialysispartial-thickness skin graftingsodium thiosulfate

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