Calciphylaxis – a challenging & solvable task for plastic surgery? A case report

Abstract

BackgroundCalciphylaxis (calcific uremic arteriolopathy) is rare and its pathogenesis is not fully understood. Indeed, Calciphylaxis presents a challenge through the course of its management which involve different specialities but unfortunately this disease so far has a poor prognosis. We herein present, in this case report, a multidisciplinary approach involving plastic surgeons with special regards to reconstructive approach after debridement procedures.Case presentationWe present a 21 years old male with a BMI of 38,2, who was transferred to our department from another hospital. Calciphylaxis has been diagnosed after receiving anticoagulation with phenprocoumon after a single event of pulmonary embolism. The INR on admission was 1,79. He had necrotic spots on both sides of the abdominal wall and on both thighs medially. During this time he underwent several reconstructive procedures in our department.ConclusionIt can be suggested that this agonizing disease needs indeed a multidisciplinary approach involving Nephrologists, Dermatologists, Intensive Care Physicians and Plastic Surgeons, taking into consideration that surgical correction can achieve further improvement in a specialized centre. Notwithstanding, further cohort studies should be approached clinically to insight the light on this disease with special regard to the prognosis after this approach.

Calciphylaxis: from the disease to the diseased

“…Targeted therapies have been mentioned in the literature as a promising innovation in the management of CUA [6,10]. However, it is likely that prevention, multidisciplinary care and avoidance of iatrogeny should remain the foundations in the management of CUA [11,20,45,50,56,66].…”

“…Cutaneous CUA typically presents as a biphasic process [44,56]. Each phase may be understood as a set of clinical consequences of specific histologic lesions belonging to a continuum towards tissue necrosis.…”

“…Phase two consists of painful ischemic necrosis which manifests as non-healing ulcerations and black deep eschars. Infection, abscess formation and gangrene frequently follow the appearance of these lesions [6,9,10,35,36,38,56].…”

Biomarkers of an Autoimmune Skin Disease—Psoriasis

“…However, thorough studies and data at the intersection of metabolomics and psoriasis are currently limited. Sitter et al [60] examined and compared metabolic patterns between unaffected skin and psoriatic skin, as well as corticosteroid-treated psoriatic skin with 1D 1 H nuclear magnetic resonance (NMR) spectroscopy. They found lower metabolite levels of glucose and myo-inositol, but higher levels of taurine and choline in tissue biopsies from psoriatic skin compared to unaffected skin.…”

Dermolipectomie abdominale et mastectomie bilatérale subtotale dans le cadre d’une calciphylaxie : à propos d’un cas et mise au point

“…Ces lésions sont le plus souvent multiples et bilatérales. Certains auteurs distinguent deux formes, distale (membres) et proximale (tronc, flanc, cuisse) et attribuent un pronostic plus défavorable à la seconde (60 à 80 % de mortalité vs 20 à 30 %) en raison de la possible extension en profondeur [5,6].…”