Calciphylaxis in the Upper GI Tract in an ESRD Patient: An Atypical Presentation and Review of Literature

Area of Science:

• Nephrology
• Pathology
• Gastroenterology

Background:

• Calcific uremic arteriolopathy (CUA), or calciphylaxis, is a rare vascular disease.
• CUA predominantly affects end-stage renal disease (ESRD) patients on dialysis, causing painful skin ulcers.
• Visceral CUA presentations are less common but can be life-threatening.

Purpose of the Study:

• To report an exceptional case of gastric mucosal CUA.
• To highlight upper gastrointestinal bleeding as an atypical presentation of CUA.
• To emphasize the need for vigilance in diagnosing visceral CUA in ESRD patients.

Main Methods:

• Case report of a dialysis-dependent ESRD patient.
• Histopathologic examination of gastric biopsies.
• Review of clinical presentation and outcome.

Main Results:

• Gastric mucosal CUA was diagnosed in an ESRD patient presenting with severe upper gastrointestinal bleeding.
• The patient had no preceding skin lesions.
• Despite treatment, the patient experienced a fatal outcome due to poor adherence.

Conclusions:

• Gastric CUA is a rare but critical diagnosis in ESRD patients.
• Atypical visceral presentations of CUA require a high index of suspicion.
• Prompt recognition and management are vital, though challenging.