Aggressive calciphylaxis in end-stage renal disease after a failed kidney allograft

Charat Thongprayoon, Wisit Cheungpasitporn, Jackrapong Bruminhent

 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

Correspondence Address:
Charat Thongprayoon
Mayo Clinic, Rochester, MN, 55905
USA

A 71-year-old woman with end-stage renal disease (ESRD) after a failed kidney transplant presented with painful wounds on her right thigh over the last 4 months. Physical examination revealed purple, firm, subcutaneous, indurated plaques with superficial skin breakdown with black eschar on her right medial thigh [[Figure - 1]a]. X-ray of her right thigh demonstrated extensive vascular calcification and soft tissue calcification [[Figure - 1]b]. A skin biopsy confirmed the diagnosis of calciphylaxis. Her treatment included sodium thiosulfate, tissue plasminogen activator administration, aggressive dialysis, and wound debridement with hyperbaric oxygen therapy. Unfortunately, she passed away after palliative care.

Figure 1: (a) Purple, firm, subcutaneous, indurated plaques with superficial skin breakdown with black eschar on right medial thigh. (b) X-ray of right thigh demonstrating extensive vascular calcification and soft tissue calcification (arrow)