Clinical mimickers of calciphylaxis: A retrospective study

Gabel, Colleen K.; Blum, Amy E.; François, Josie; Chakrala, Teja; Dobry, Allison S.; Garza-Mayers, Anna Cristina; Ko, Lauren N.; Nguyen, Emily; Shah, Radhika; John, Jessica St.; Nigwekar, Sagar U.; Kroshinsky, Daniela

doi:10.1016/j.jaad.2021.03.035

Cited by 8 publications

(12 citation statements)

References 24 publications

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“…The disease is often accompanied by disorders such as hyperphosphatemia, elevated parathyroid hormone levels [4]. Calciphylaxis has been reported to have a misdiagnosis rate as high as 73% with cellulitis being the most common misdiagnosis [5]. Given this fact, it is similar to what happened to our patient.…”

Section: Discussionsupporting

confidence: 77%

Calciphylaxis Before ESRD: A Rare Case Report.

Affas¹

2022

JCMCR

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Introduction: Calciphylaxis, small vessel vasculopathy, is a rare, but serious disorder that usually occurs in a patient with End-stage renal disease (ESRD). It is characterized by the deposition of calcium in the arteriole's intimal layer with the consequent proliferation, fibrosis, and thrombosis of that layer. The diagnosis requires high clinical suspicion, as it usually presenting as atypical painful skin nodules or subcutaneous hard mass, or in advance cases, can present as an ischemic ulcer. This disorder is known to be associated with ESRD, however, rarely it starts before ESRD.We hereby, presenting a case of calciphylaxis that was missed for around two years, as it presented Atypically in a patient weeks before becoming ESRD. Aim:The aim of this study is to increase physician awareness about this rare medical condition and to highlight the possibility of this disease starting before the patient's renal insufficiency advanced to the ESRD level.Case report: An 82-year-old female with a Body mass index (BMI) of 30 and a past medical history of ESRD on home hemodialysis, insulin-dependent diabetes mellitus, presented with an event of fall. Her review of the systems showed that she is been complaining of subcutaneous hard and tender nodules in her lower extremities, mainly thighs and below knees, for more than 2 years. On examination: she had painful hard subcutaneous nodules that was movable and with no ulcer/ redness or fluctuation. Her labs showed elevated BUN and creatinine along with Hyperphosphatemia. Computed tomography (CT) scan and bone scan were consistent with calciphylaxis. This calciphylaxis was started before the peritoneal dialysis 2 years ago and was not ruptured or ulcerate at any time. The diagnosis of calciphylaxis was made clinically given the history of these painful nodules and associated risk factors of Hyperphosphatemia, Obesity, Female and Diabetic Mellitus. And was strengthened by the CT scan and bone scan findings. Conclusion: Calciphylaxis (calcific uremic arteriolopathy) is a rare but serious disorder that usually occurs in patients with ESRD but can occur in patients without ESRD or before the ESRD. The diagnosis can be based on clinical grounds and supported by excluding another differential diagnosis, ESRD-associated labs if present along with high phosphate and calcium can also support the diagnosis. Imaging and histological analysis, if possible, can also help and support the diagnosis. All the physicians and mainly (Dermatologist and PCP) must have a high level of awareness of this condition as the early detection and treatment can help in improving the outcome.

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Section: Discussionsupporting

confidence: 77%

Calciphylaxis Before ESRD: A Rare Case Report.

Affas¹

2022

JCMCR

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“… 6 Calciphylaxis has recently been reported to have a misdiagnosis rate as high as 73% with cellulitis being the most common misdiagnosis. 7 The clinical presentation of calciphylaxis may vary, and early lesions can be erythematous or violaceous, and painful. As vascular occlusion progresses, ischemic changes can present as livedo reticularis, retiform purpura, ulceration, and tissue necrosis.…”

Section: Discussionmentioning

confidence: 99%

Early diagnosis and intervention of calciphylaxis leading to rapid resolution

et al. 2021

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“…36 In one retrospective study of 119 patients, there was a misdiagnosis rate of approximately 73% in patients with calciphylaxis. 37 The most frequent initial diagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). 37 However, patients with ESKD were less likely to be misdiagnosed upon initial presentation (p = 0.01), suggesting that the classical association between ESKD and calciphylaxis may prime providers to maintain calciphylaxis higher in their differential diagnosis in these cases versus in situations in which there is no known renal disease .…”

Section: Diagnosis Of Calciphylaxismentioning

confidence: 99%

“…37 The most frequent initial diagnoses were cellulitis (31.0%), unspecified skin infection (8.0%), and peripheral vascular disease (6.9%). 37 However, patients with ESKD were less likely to be misdiagnosed upon initial presentation (p = 0.01), suggesting that the classical association between ESKD and calciphylaxis may prime providers to maintain calciphylaxis higher in their differential diagnosis in these cases versus in situations in which there is no known renal disease . 37 Other mimickers of calciphylaxis exist, including diffuse dermal angiomatosis which may manifest as pink or hyperpigmented patches, retiform purpura, or ulceration in patients with ESKD.…”

Section: Diagnosis Of Calciphylaxismentioning

confidence: 99%