A Case of Nonuremic Calciphylaxis in a Caucasian Woman

Fergie, Bonnie; Valecha, Nishant; Miller, Andrew

doi:10.1155/2017/6831703

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…One study using IV pamidronate did not report the outcome of complete closure 28 . The report of zoledronate treatment did not report the outcome of complete closure 27 . Three studies using IV STS treatment reported complete closure after 4 months, 6 months, and 42 weeks (9.8 months) 29,33,34 .…”

Section: Discussionmentioning

confidence: 99%

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Topical cannabis‐based medicines – A novel paradigm and treatment for non‐uremic calciphylaxis leg ulcers: An open label trial

Maida

Shi

Fazzari

et al. 2020

International Wound Journal

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Non‐Uremic Calciphylaxis (NUC) is a rare condition that often manifests as intractable and painful integumentary wounds, afflicting patients with a high burden of co‐morbidity. The Endocannabinoid System (ECS) is a ubiquitous signalling system that is theorised to be dysregulated within wound beds and associated peri‐wound tissues. Preclinical research has shown that the dominant chemical classes derived from the cannabis plant, cannabinoids, terpenes, and flavonoids, interact with the integumentary ECS to promote wound closure and analgesia. This is a prospective open label cohort study involving two elderly Caucasian females with recalcitrant NUC leg ulcers of greater than 6 months duration. Topical Cannabis‐Based Medicines (TCBM) composed of cannabinoids, terpenes, and flavonoids were applied daily to both the wound bed and peri‐wound tissues until complete wound closure was achieved. Wounds were photographed regularly, and the digital images were subjected to planimetric analysis to objectively quantify the degree of granulation and epithelization. Analgesic utilisation, as a surrogate/proxy for pain scores, was also tracked. The cohort had a mean M3 multimorbidity index score of 3.31. Complete wound closure was achieved in a mean of 76.3 days. Additionally, no analgesics were required after a mean of 63 days. The treatments were well tolerated with no adverse reactions. The positive results demonstrated in very challenging wounds such as NUC, among highly complex patients, suggest that TCBM may have an even broader role within integumentary and wound management. This treatment paradigm warrants being trialled in other wound types and classes, and ultimately should be subjected to randomised controlled trials.

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Section: Discussionmentioning

confidence: 99%

“…28 The report of zoledronate treatment did not report the outcome of complete closure. 27 Three studies using IV STS treatment reported complete closure after 4 months, 6 months, and 42 weeks (9.8 months). 29,33,34 Three other studies using IV STS did not the outcome of complete closure.…”

Section: Discussionmentioning

confidence: 99%

Topical cannabis‐based medicines – A novel paradigm and treatment for non‐uremic calciphylaxis leg ulcers: An open label trial

Maida

Shi

Fazzari

et al. 2020

International Wound Journal

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“…This drug is described as a risk factor in some cases, however, in most of those cases, additional risk factors as described earlier were present [2-5]. Only very few cases reported no risk factor other than previous warfarin usage in the literature [5-7]. Calciphylaxis is twice more common in female and it is reported in the fifth decade of life [8].…”

Section: Resultsmentioning

confidence: 99%

Non-uremic Calciphylaxis: A Rare and Late Adverse Reaction of Warfarin

Patel

Patel²,

Patel

et al. 2019

CDS

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Background: Calciphylaxis is a complex dermatological lesion of micro vascular calcification that is typically presented as panniculitis with gangrenous painful lesions having uremic and non-uremic causes.Case Report: We present a case of a 48-year old male with a history of paroxysmal atrial fibrillation and hypertension taking amlodipine 5 mg and warfarin 5 mg daily for the last 26 months. The patient had a 6-months history of painful swelling followed by necrotic skin ulcer over the right leg. His remarkable examination findings were right leg tender ulcer with surrounding erythema and secondary sepsis. His hemogram, metabolic profile and connective tissue diseases work up were unremarkable except leucocytosis and raised inflammatory markers. His local part radiological and skin biopsy findings were suggestive of calciphylaxis.Results and Conclusion: In our case, warfarin and amlodipine were culprit drugs for the lesion, but Naranjo score (warfarin 7and amlodipine 1) speculate warfarin as a probable adverse reaction of warfarin. The lesion was cured with local wound treatment after discontinuation of warfarin. The physician should be aware of this rare cutaneous disorder of systemic origin for proper management.

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“…The lesions present as indurated plaques or nodules that may have ulcerations and eschar and can be associated with livedo reticularis[10]. A tissue biopsy is essential to confirm the diagnosis[11,12]. Histopathologic changes are similar in both uremic and non-uremic calciphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Non-uremic calciphylaxis associated with alcoholic hepatitis: A case report

Sammour¹,

Saleh²,

Gad³

et al. 2019

WJH

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BACKGROUNDCalciphylaxis is a form of vascular calcification more commonly associated with renal disease. While the exact mechanism of calciphylaxis is poorly understood, most cases are due to end stage kidney disease. However, it can also be found in patients without kidney disease and in such cases is termed non-uremic calciphylaxis for which have multiple proposed etiologies.CASE SUMMARYWe describe a case of a thirty-year-old morbidly obese Caucasian female who had a positive history of alcoholic hepatitis and presented with painful calciphylaxis wounds of the abdomen, hips, and thighs. The hypercoagulability panel showed low levels of Protein C and normal Protein S, low Antithrombin III and positive lupus anticoagulant and negative anticardiolipin. Wound biopsy confirmed the diagnosis of non-uremic calciphylaxis in the setting of alcoholic liver disease. The calciphylaxis wounds did not improve when Sodium Thiosulfate was used alone. The patient underwent a series of bedside and surgical debridement. Broad spectrum antibiotics were also used for secondary wound bacterial infections. The patient passed away shortly after due to sepsis and multiorgan failure.CONCLUSIONNon-uremic Calciphylaxis can occur in the setting of alcoholic liver disease. The treatment of choice is still unknown.

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A Case of Nonuremic Calciphylaxis in a Caucasian Woman

Cited by 5 publications

References 8 publications

Topical cannabis‐based medicines – A novel paradigm and treatment for non‐uremic calciphylaxis leg ulcers: An open label trial

Topical cannabis‐based medicines – A novel paradigm and treatment for non‐uremic calciphylaxis leg ulcers: An open label trial

Non-uremic Calciphylaxis: A Rare and Late Adverse Reaction of Warfarin

Non-uremic calciphylaxis associated with alcoholic hepatitis: A case report

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