Vitamin K Antagonist-Induced Calciphylaxis in a Dialysis Patient With Antiphospholipid Syndrome: A Multidisciplinary...

Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a rare, life-threatening syndrome characterized by microvascular calcification and cutaneous necrosis, predominantly affecting patients with end-stage renal disease (ESRD) on maintenance dialysis, particularly those exposed to vitamin K antagonists (VKAs). We report the complex clinical course of a 35-year-old female patient with chronic kidney failure and triple-positive antiphospholipid syndrome (APS) who presented with severe, painful bilateral thigh ulcerations. The patient had been receiving phenprocoumon for 2 years. Given her high-risk profile for thrombosis, managing cutaneous necrosis while maintaining necessary anticoagulation presented a profound clinical dilemma. Histopathological evaluation confirmed the diagnosis of calciphylaxis. VKA therapy was immediately discontinued and replaced with renal-adjusted apixaban to manage her underlying APS as an individualized rescue strategy. A multimodal, sequential wound care regimen was initiated, incorporating serial surgical debridements, negative pressure wound therapy (NPWT), autologous platelet-rich plasma (PRP) infiltration, and acellular fish skin grafting. Following intensive multidisciplinary intervention involving vascular surgery, nephrology, and dermatology, the progression of the disease was successfully halted. Significant wound contraction, stable granulation, and complete epithelialization were achieved without systemic complications. This case underscores that short-term VKA exposure can act as a critical trigger for calciphylaxis in patients with multifactorial risk profiles and demonstrates that a tailored transition to novel oral anticoagulants combined with advanced wound therapies can achieve favorable outcomes in highly complex, refractory scenarios.