Calciphylaxis is the uncommon condition of calcium and phosphate deposition outside of bone. It typically occurs in chronic end-stage renal disease, particularly with diabetes mellitus. Treatment is difficult and associated mortality high.
CaseA 70-year-old man presented with acute renal failure and sepsis. Clinically he was pyrexial, hypotensive and tachycardic. His abdomen had previous surgical scars, but his examination was otherwise unremarkable. Urine cultures were positive for Escherichia coli. He had a background of a similar admission one month previously, prostate cancer with spinal metastases, colon cancer with left hemicolectomy and bilateral ureteric stents for hydronephrosis.His creatinine had risen from 110 mmol/L to 971 mmol/L with urea 82.4 mmol/L. His phosphate was 3.4 mmol/L and corrected calcium 2.66 mmol/L, giving a calcium phosphate product of 7.4. He was transferred to the intensive care unit for haemofiltration and intravenous antibiotics. On day 3 he developed painful widespread lesions on his lower legs with violaceous edges which developed a black eschar over 24 h. Autoimmune profile and ANCA screen were negative. Parathyroid hormone level was 17.7 pmol/L. Skin biopsies confirmed calciphylaxis.This man was rehydrated and his renal function and serum calcium improved. His planned assessment by the plastic surgeons was delayed as he developed recurrent Gram-negative septicaemia and he died a few months later.
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