Calcific Uremic Arteriolopathy: All Skin and Bones

Presentation Number: SAT 300
Date of Presentation: April 1st, 2017

Sowjanya Naha*1, Pratyusha Bollimunta2, Kushal Naha2 and Farah Faridi2
1Presence Saint Francis Hospital, 2Presence Saint Francis Hospital, Evanston, IL

Abstract

Introduction: Calcific uremic arteriolopathy also known as calciphylaxis is a rare and serious disorder characterized by painful ischemic skin necrosis and calcification of dermal arterioles on histological examination. It is typically seen in patients with end-stage renal disease (ESRD) on dialysis.

Case report: We report a 67 year old Caucasian female who presented with features of sepsis. The putative source was cellulitis of her lower extremities at the site of multiple painful non-healing skin ulcerations that had gradually developed in the past two months. Past medical history was notable for ESRD on hemodialysis for about six months, as well as chronic atrial fibrillation on therapeutic anticoagulation with warfarin. Review of previous blood work showed elevated parathyroid hormone (PTH) of over 1000 pg/mL. Biopsy of the skin lesions demonstrated arteriolar wall calcification consistent with calciphylaxis. Sodium thiosulfate was initiated with every hemodialysis session in addition to the broad spectrum antibiotics that she was already receiving. Warfarin therapy was discontinued. The patient reported symptomatic improvement with these measures. She continues to receive treatment with sodium thiosulfate as of this day.

Conclusion: Calciphylaxis carries a grave prognosis with a one-year survival rate of less than 50%. It is frequently complicated by infection as was seen in this instance. The incidence of calciphylaxis is expected to rise in the immediate future paralleling the rapid growth of the ESRD population in the US. Physicians should therefore be aware of this unusual but deadly etiology for painful non-healing wounds.

 

Nothing to Disclose: SN, PB, KN, FF