Tag Archives: Calciphylaxis

MR with The Kanch: Calciphylaxis

An older woman who presented with worsening shortness of breath and lower extremity rash found to be severely anemic and in renal failure.  She was later diagnosed with calciphylaxis and started on hemodialysis.
– Calciphylaxis or “calcific uremic arteriolopathy” is part of a continuum of the systemic vascular and soft-tissue calcification that is common in end-stage renal disease (ESRD) – clinical manifestations result from reductions in the arteriolar blood flow
-Calciphylaxis is a clinical diagnosis – this patient did have a biopsy which further supported – calciphylaxis is usually VERY painful – this case was unique in that the patient only had mild pain
Biopsy can be dangerous and can worsen the lesions, so take this into account when considering biopsy!
-Treatment of choice for post patients is IV sodium thiosulfate – which is given during dialysis
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7/13 Morning Report Image

A 74F w/ ESRD on HD, DM comes with in a painful rash that has grown over 3 weeks.
Inline image 1
Diagnosis in ESRD: Calciphylaxis!
*Description: “painful black eschar with slight surrounding angulated purpura”
*Associated with elevated calcium-phosphorous product
*Due to calcium deposition in vessels -> distal ischemia -> tissue necrosis
*Prognosis 60 to 80% in 1 year, often due to infectious complications
Differential diagnosis of black eschar: think infections (mostly fungal) and vascular (see http://www.evernote.com/l/AHam3_xniGtPorodk6Z4TZLnAFiU_EAi9lM/ )
*Infections
-Fungal: Aspergillus, mucormycosis, cryptococcus
-Bacterial: Pseudomonas ecthyma gangrenosum, anthrax
*Vascular
-gangrene
-Calciphylaxis
-Warfarin necrosis
-vasculitis
-purpura fulminans
-APLS