Diffuse dermal angiomatosis associated with calciphylaxis in a patient with end‐stage renal disease

Steele, Katherine T.; Sullivan, Brendan; Wanat, Karolyn A.; Rosenbach, Misha; Elenitsas, Rosalie

doi:10.1111/cup.12183

Cited by 22 publications

(22 citation statements)

References 15 publications

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“…The relationship between CP and DDA has been described in four published papers to date, for a total of 16 cases. Prinz Vavricka et al concluded that DDA is a common histopathologic finding in the dermis adjacent to necrotizing ulcers in patients with CP; however, the “extent of DDA did not correlate with the gravity or severity of disease.” McMullen et al examined the specificity of fine calcium deposits in vessel walls for CP and found that DDA was only seen in association with CP and no other causes of vascular calcification, namely, gangrene, amputations, chronic stasis, and thrombotic vasculopathy.…”

Section: Introductionmentioning

confidence: 99%

Diffuse dermal angiomatosis associated with calciphylaxis: A 5‐year retrospective institutional review

O’Connor

Lauzon

et al. 2019

J Cutan Pathol

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Background: Although diffuse dermal angiomatosis (DDA), a rare acquired reactive cutaneous vascular disorder, has been previously reported in association with calciphylaxis (CP), the clinical significance of this relationship has not yet been elucidated.Methods: A total of 24 cases of CP diagnosed from 2013 to 2018 were retrospectively reviewed for the presence of associated DDA. Pertinent clinical information for each patient was also collected, and statistical analysis was performed using multivariable logistic regression, Student t test and Fisher exact test.Results: African American race and comorbid congestive heart failure were the only variables that demonstrated independent, statistically significant association with the presence of DDA. End-stage renal failure, diabetes mellitus, immunosuppressive and hypercoagulable states, arrhythmia, body mass index, hypertension, coronary artery disease, patient age, duration of CP symptoms, gender, time interval from biopsy to death, anticoagulation therapy and sodium thiosulfate administration at the time of biopsy did not demonstrate a statistically significant association with DDA.Conclusion: DDA does not appear to be associated with disease severity or prognosis in cases of CP; however, in our population CP with concurrent DDA was more prevalent in African Americans and individuals with congestive heart failure. K E Y W O R D Scalciphylaxis, congestive heart failure, diffuse dermal angiomatosis, pseudokaposiform

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Section: Introductionmentioning

confidence: 99%

Diffuse dermal angiomatosis associated with calciphylaxis: A 5‐year retrospective institutional review

O’Connor

Lauzon

et al. 2019

J Cutan Pathol

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“…10,11 Diffuse dermal angiomatosis has been reported in association with calciphylaxis, and the extensive proliferation of endothelial cells between collagen fibers in the dermis can mimic a vascular neoplastic process. 12,13 Subcutaneous pauci-inflammatory thrombogenic vasculopathy has been proposed to be the main pathology 14 while the timing and propensity for development of cutaneous microvascular calcific deposits remain uncertain. 15 Special stains such as von Kossa or Alizarin red can highlight calcium phosphate deposits not seen through routine light microscopy.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with false‐negative pathologic diagnosis of calciphylaxis

et al. 2018

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Background Calciphylaxis is a rare, painful, and debilitating disorder of vascular calcification and skin necrosis that typically affects patients with advanced kidney disease. During our routine pathology practice, we noted several missed diagnoses on calciphylaxis consultation cases originating from outside institutions and sought to explore factors associated with false‐negative pathologic diagnosis of calciphylaxis. Methods The pathology database of a large tertiary academic medical center was retrospectively searched for “calciphylaxis” in inside reports on outside surgical consultation cases between 2007 and 2017. Inside and outside pathology reports were compared and medical records were searched for calciphylaxis clinical diagnosis and risk factors. Results Twenty‐four calciphylaxis patients were identified, with median age of 63.5 years. Seven of 24 (29%) of specimens were inadequate (e.g., lack of subcutaneous adipose tissue for evaluation). Eight of 17 (47%) of adequate specimens had a first false‐negative pathologic diagnosis of calciphylaxis. Histochemical staining for calcium significantly correlated with true‐positive diagnosis (93% vs 55%, P = 0.004). Dermatopathology fellowship training significantly correlated with true‐positive diagnosis (82% vs 38%, P = 0.047). Conclusions Adequate sampling, dermatopathology training, and use of histochemical stains to identify calcium associate with decreased false‐negative rate for calciphylaxis diagnosis. These findings need further evaluation in larger prospective studies.

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“…DDA has been reported on the forearm secondary to iatrogenic arteriovenous fistulas in chronic hemodialysis patients and in women with nonhealing, ulcerating lesions on the breast [ 3 , 4 ]. In addition, this cutaneous reactive pattern has also been reported in association with a variety of diseases that cause vasculopathy, including calciphylaxis [ 5 , 6 ], monoclonal gammopathy [ 7 , 8 ] and cutis marmorata telangiectatica congenita [ 9 ]. The differential diagnosis of DDA includes vasculopathy, medium to large vessel vasculitis, acroangiodermatitis and benign or malignant vascular tumor.…”

Section: Discussionmentioning

confidence: 93%

Diffuse Dermal Angiomatosis: A Clue to the Diagnosis of Atherosclerotic Vascular Disease

Sriphojanart

Vachiramon

2015

Case Rep Dermatol

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Diffuse dermal angiomatosis (DDA) is a benign, acquired, reactive vascular proliferation. DDA is clinically characterized by painful purpuric plaque with central ulceration. The histopathologic hallmark is diffuse proliferation of endothelial cells that are arranged interstitially between collagen bundles of the reticular dermis. DDA has been reported in association with peripheral atherosclerotic disease, arteriovenous fistula and heavy smoking. We report the case of a 49-year-old Asian male with DDA who presented with a painful stellate-shaped purpuric patch on the right thigh. Histopathologic examination showed proliferation of CD34-positive spindle cells in the dermis. Our patient underwent vascular bypass surgery along with tight control of cardiovascular risk factors, which yielded successful results.

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Diffuse dermal angiomatosis associated with calciphylaxis in a patient with end‐stage renal disease

Cited by 22 publications

References 15 publications

Diffuse dermal angiomatosis associated with calciphylaxis: A 5‐year retrospective institutional review

Diffuse dermal angiomatosis associated with calciphylaxis: A 5‐year retrospective institutional review

Factors associated with false‐negative pathologic diagnosis of calciphylaxis

Diffuse Dermal Angiomatosis: A Clue to the Diagnosis of Atherosclerotic Vascular Disease

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