Calciphylaxis mimicking ecthyma gangrenosum

Ecthyma gangrenosum is a cutaneous infection classically associated with Pseudomonas aeruginosa as the causative pathogen, but other gram-negative enteric flora can be found. This infection is typically seen in immunocompromised patients in the setting of fulminant bacteremia with lesional features of gangrenous ulceration surrounded by tender erythematous borders. In patients with hematological malignancies, prompt recognition of this entity through microbiological and clinical features is critical to ensuring successful treatment and resolution. As patients with refractory leukemia live longer with breakthroughs in therapy, infectious complications are becoming more common along with increasing resistant gram-negative pathogens. Herein, we present 9 cases of ecthyma gangrenosum caused by multidrug-resistant gram-negative bacteria in leukemia patients with prolonged neutropenia, which were successfully managed with combination antibiotic therapy.

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Sodium Thiosulfate for Calciphylaxis Treatment in Patients on Peritoneal Dialysis: A Systematic Review

Gossett

Suppadungsuk

Krisanapan

et al. 2023

Medicina

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Limited data are available on the utilization of sodium thiosulfate (STS) treatment for calciphylaxis in peritoneal dialysis (PD) patients, while it is well-studied in hemodialysis (HD) patients. A systematic literature search was conducted using Ovid MEDLINE, EBM Reviews—Cochrane Central Register of Controlled Trials, and EBM Reviews—Cochrane Database of Systematic Reviews to identify reported cases of PD patients with calciphylaxis who received STS. The search covered the inception of the databases through August 2022. Across 19 articles, this review identified 30 PD patients with calciphylaxis who received STS. These included 15 case reports, 2 case series, and 2 cohort studies. The administration routes and doses varied depending on the study. For intravenous (IV) administration (n = 18), STS doses ranged from 3.2 g twice daily to 25 g three times weekly for 5 weeks to 8 months. Outcomes included 44% of patients experiencing successful wound healing, 6% discontinuing STS due to adverse effects, 67% transitioning to HD, and 50% dying from calciphylaxis complications. For intraperitoneal (IP) administration (n = 5), STS doses ranged from 12.5 to 25 g three to four times weekly for 12 h to 3 months. Results showed 80% of patients achieving successful wound healing, 80% discontinuing STS due to adverse effects, 40% transitioning to HD, and 20% dying from IP STS-related chemical peritonitis. In cases where patients switched from IV to IP STS (n = 3), doses ranged from 12.5 to 25 g two to three times weekly for 2.5 to 5 months. Among them, 67% experienced successful wound healing, while 33% died from sepsis. Two cases utilized oral STS at a dose of 1500 mg twice daily for 6 and 11 months, resulting in successful wound healing without adverse effects or need for HD. However, one patient (50%) died due to small bowel obstruction. This systematic review provides an overview of STS treatment for PD patients with calciphylaxis. Although successful treatment cases exist, adverse effects were significant. Further research, including larger clinical studies and pharmacokinetic data, is necessary to establish the optimal route, dose, and efficacy of STS in PD patients.

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Calciphylaxis mimicking ecthyma gangrenosum

Cited by 3 publications

References 9 publications

Calciphylaxis: Diagnostic and Treatment Advances for the Inpatient Dermatologist

Calciphylaxis: Diagnostic and Treatment Advances for the Inpatient Dermatologist

Ecthyma Gangrenosum Secondary to Multidrug-Resistant Gram-Negative Rod Infections in Leukemia Patients With Prolonged Neutropenia

Sodium Thiosulfate for Calciphylaxis Treatment in Patients on Peritoneal Dialysis: A Systematic Review

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