Calciphylaxis: a rare cause of limb ulcer – a case report

Authors

  • Roberto Cunha Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal https://orcid.org/0000-0003-2252-9872
  • Manuel Silva Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal
  • Vítor Carneiro Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal
  • Pedro Sousa Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal https://orcid.org/0000-0001-6999-3539
  • Mafalda Correia Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal https://orcid.org/0000-0002-1134-7400
  • Isabel Vieira Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal https://orcid.org/0000-0002-8131-6116
  • Isabel Cássio Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal
  • Nelson Oliveira Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal https://orcid.org/0000-0002-6737-3691
  • Emanuel Dias Serviço de Angiologia e Cirurgia Vascular do Hospital Divino Espírito Santo, Ponta Delgada, Portugal

DOI:

https://doi.org/10.48750/acv.546

Keywords:

Calciphylaxis, Calcific uremic arteriolopathy, End stage renal disease, Vascular surgery

Abstract

BACKGROUND: Calciphylaxis is a rare disease with a poor prognosis predominantly found in end-stage renal disease patients treated with dialysis. This pathology most commonly presents with painful non-healing ulcers, predisposing to high risk of sepsis and death. The authors present a case of bilateral leg ulcers due to calciphylaxis.
CASE REPORT: A 40-year-old female patient presented with painful ulcers in both lower limbs, for two months. She had a history of end-stage renal disease, morbid obesity, severe hypertension, arterial fibrillation and secondary hyperparathyroidism. Duplex examination releveled biphasic curves in the foot arteries. The ankle-brachial index was carried out with a result of 1.1, obtaining a WIFi stage of 3 (2/0/2). Venous disease was excluded. A biopsy was obtained, revealing small thick-walled vessels with dystrophic calcification of the intima and media. After surgical debridement, antibiotics directed at the superimposed infection were administered and local wound care with chemical debridement was performed. The ulcers healed completely after 8 weeks and there was no recurrence after 6 months.
CONCLUSION: The diagnosis is made by clinical and histological findings. Treatment involves a multidisciplinary approach with medical treatment and wound care. Drugs such as sodium thiosulphate and cinacalcet have shown good results in the healing of ulcers. Vascular surgeons, as they often deal with patients with leg ulcers, should be aware of calciphylaxis as a differential diagnosis when vascular disease is excluded.

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References

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Seethapathy H, Brandenburg VM, Sinha S, El-Azhary RA, Nigwekar SU. Review: Update on the management of calciphylaxis. QJM. 2019;112:29–34.

Milas M, Bush RL, Lin P, Brown K, Mackay G, Lumsden A, et al. Calciphylaxis and nonhealing wounds: The role of the vascular surgeon in a multidisciplinary treatment. J Vasc Surg. 2003;37:501–7.

McCarthy JT, el-Azhary RA, Patzelt MT, Weaver AL, Albright RC, Bridges AD, et al. Survival, Risk Factors, and Effect of Treatment in 101 Patients With Calciphylaxis. Mayo Clin Proc. 2016;91:1384–94.

Zuhaili B, Al-Talib K. Successful Treatment of Single Infected Calciphylaxis Lesion With Intralesional Injection of Sodium Thiosulfate at High Concentration.Wounds. 2019;13:E54-7

Dwyer KM, Francis DMA, Hill PA, Murphy BF. Calcific uraemic arteriolopathy: Local treatment and hyperbaric oxygen therapy. Nephrol Dial Transplant. 2002;17:1148–9.

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Published

2024-03-03

How to Cite

1.
Cunha R, Silva M, Carneiro V, Sousa P, Correia M, Vieira I, Cássio I, Oliveira N, Dias E. Calciphylaxis: a rare cause of limb ulcer – a case report. Angiol Cir Vasc [Internet]. 2024 Mar. 3 [cited 2024 Jul. 13];19(4):235-8. Available from: https://acvjournal.com/index.php/acv/article/view/546

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Section

Clinical Case

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