An Intensive Multidisciplinary Approach in Management of Extensive Nonuremic Calciphylaxis of the Bilateral Lower Extremities with Angioinvasive Fungus and Mold

Abstract

Management of infected wounds related to calciphylaxis poses a significant clinical challenge with high morbidity and mortality. Given no definitive management guidelines exist specific to nonuremic calciphylaxis, multiple modalities including sodium thiosulfate, antibiotics, hyperbaric oxygen therapy, and surgical debridement with wound care must be considered. When occurring over a large surface area, standard daily dressing changes are especially labor intensive, inefficient, and ineffective. Negative pressure wound therapy with instillation and dwell time offers broad wound coverage with ongoing therapeutic benefit. We present the case of a previously healthy 19-year-old woman who was transferred for tertiary level care of extensive nonuremic calciphylaxis wounds of the bilateral lower extremities complicated by angioinvasive coinfection with fungus and mold that was managed with a multidisciplinary approach of intensive medical management, aggressive surgical debridement, and negative pressure wound therapy with instillation of hypochlorous acid solution. Ultimately, she achieved full granulation and wound coverage with skin grafting. Large area, infected wounds related to nonuremic calciphylaxis can be successfully managed with multidisciplinary medical management, aggressive surgical debridement, and negative pressure wound therapy that can instill and dwell hypochlorous acid solution.

Successful treatment of an infected wound involving calciphylaxis via vacuum sealing drainage: A case report

“…As the initial measures of wound care, serial debridement and STS treatment have not slowed down the progress of the disease in this case, the VSD along with the creative use of topical antibiotic flushing provided the best solution to promote healing of the infected field within 12 weeks in this case. Recently, Roberson et al presented a case of extensive calciphylaxis wounds of the bilateral lower extremities complicated by angioinvasive coinfection in a young female patient and a complete resolution of the lesion with almost tissue coverage occurred through a multidisciplinary approach within 26 weeks [8] . Our case highlights that VSD therapy is effective for infected wounds and healing was faster if the wound infection was completely removed.…”

Occlusive cutaneous vasculopathies as cause of chronic ulcers

“…In general, there are no special recommendations for topical wound management in vasculopathies even though individual case reports have been published for some treatment methods such as split skin grafting, negative pressure treatment, or hyperbaric oxygen therapy. 92,93 The M.O.I.S.T. scheme offers a guide for topical treatment in chronic wounds.…”

“…There are a number of measures that can be applied independent of the underlying disease; these will be described in detail below. In general, there are no special recommendations for topical wound management in vasculopathies even though individual case reports have been published for some treatment methods such as split skin grafting, negative pressure treatment, or hyperbaric oxygen therapy 92,93 …”

Okkludierende kutane Vaskulopathien als Ursachen chronischer Unterschenkelulzerationen

“…Prinzipiell liegen keine besonderen Empfehlungen hinsichtlich lokaler Wundtherapie bei Vorliegen einer der genannten Vaskulopathien vor, auch wenn zu einzelnen Therapieverfahren wie Spalthauttransplantation, Unterdrucktherapie oder hyperbarer Sauerstofftherapie jeweils Einzelfallberichte publiziert wurden. 92,93 Als Orientierung für lokale Therapiemaßnahmen bei chronischen Wunden kann das M.O.I.S.T.-Schema dienen. 94 Das Akronym umfasst mehrere Grundprinzipien, die zur lokalen Wundversorgung zum Einsatz kommen können.…”

“…Eine Reihe von Maßnahmen kann entitätsübergreifend angewendet werden und soll hier einmalig näher erläutert werden. Prinzipiell liegen keine besonderen Empfehlungen hinsichtlich lokaler Wundtherapie bei Vorliegen einer der genannten Vaskulopathien vor, auch wenn zu einzelnen Therapieverfahren wie Spalthauttransplantation, Unterdrucktherapie oder hyperbarer Sauerstofftherapie jeweils Einzelfallberichte publiziert wurden 92,93 …”