Calciphylaxis is a rare disorder characterized by calcification of small and medium-size arteries, causing thrombosis, tissue necrosis, and painful, nonhealing skin ulcerations. The preponderance of cases occurs in patients undergoing dialysis due to endstage renal disease. Prognosis is generally poor, with one-year mortality ranging from 45% to 80% 1,2. A recent report noted that even among nondialysis patients, renal function was moderately to severely impaired in 69% [glomerular filtration rate (GFR) < 40 ml/min] 1. Autoimmune or inflammatory conditions were present in 60%, including systemic lupus erythematosus (SLE), polymyositis, sarcoidosis, hepatitis, ulcerative colitis, rheumatoid arthritis, Sjögren's syndrome, and pemphigus. Various other risk factors are documented, including hyperparathyroidism, elevated serum calcium and phosphate, hypoalbuminemia, obesity, diabetes mellitus, and female sex, and use of warfarin, vitamin D3 analogs and calcium-containing phosphate binders 1,2. Couto, et al described a patient with secondary hypoparathyroidism due to vitamin D deficiency, with low calcium/phosphorus product, who developed calciphylaxis in the absence of endstage renal disease 3. Case reports of calciphylaxis with normal calcium/phosphorus product as well as normal renal function are limited. We describe a case of calciphylaxis in the setting of normal renal function, in a patient with SLE, secondary hyperparathyroidism due to vitamin D deficiency, and normal calcium/phosphorus product. A 76-year-old African American woman presented to hospital complaining of worsening severe pain, weight loss, fever, night sweats, and chills. Three months previously she first noted painful lesions near her hips and inner thighs. Initial outpatient punch biopsies showed lipophagic fat necrosis without calcification, the differential favoring lupus panniculitis. The wounds showed limited healing on a course of topical and oral steroids. Medical history included hypertension, atrial fibrillation, SLE (antinuclear antibodies 54 U/ml, ribonucleoprotein 245 AU/ml, anti-Smith 115 AU/ml), breast cancer status post-lumpectomy and radiation therapy, diverticulosis, and osteoarthritis. Surgical history included bilateral total knee arthroplasties. Medications were alendronate, dicyclomine, fluoxetine, furosemide, gabapentin, hydrocodone/acetaminophen, lidocaine oint