Cutaneous gangrene secondary to metastatic calcification in end stage renal failure--a case report

Metastatic calcification is a frequent association of chronic renal failure but skin involvement is accepted as a rare, albeit well recognised, complication accompanying the secondary hyperparathyroidism that results from renal impairment, although the aetiology remains unknown. Skin involvement can take the form of metastatic calcinosis cutis or cutaneous gangrene resulting from vascular calcification. There have been reported cases which describe the healing of gangrenous areas following parathyroidectomy as well as use of dietary restriction of phosphorus and phosphate binding antacids(1-6). We report a case of a 35-year-old man with end stage renal failure who presented with cutaneous gangrene but who eventually succumbed despite a subtotal parathyroidectomy and review some of the literature concerning this subject.