Extraosseous Calcification of the Esophagus: Clinicopathologic Correlates of Esophageal Mucosal Calcinosis

Garber, Ari; Arora, Zubin; Welch, Nicole; Lapinski, James; Burke, Carol A.

doi:10.14309/crj.2017.108

Cited by 4 publications

(9 citation statements)

References 7 publications

(7 reference statements)

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“…Iatrogenic calcification occurs secondary to pharmacotherapeutic intervention (i.e., sucralfate or calcium therapy). Idiopathic calcification occurs in normal tissues without hypercalcemia or hyperphosphatemia [ 1 , 5 ]. Rarely, gastric MC has been reported without an associated condition in which case it may be considered idiopathic in etiology [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, gastric MC has been reported without an associated condition in which case it may be considered idiopathic in etiology [ 7 ]. MC may be secondary to multiple factors including renal transplantation, sucralfate therapy, an elevated calcium-phosphorus product, and/or dystrophic calcification in inflamed/eroded mucosa [ 1 – 5 ]. All of the reported cases of esophageal MC, including our case, have been in patients with end stage renal disease and it seems that the most important etiologic factor in these cases was hypercalcemia or hyperphosphatemia in renal disease (i.e., metastatic calcification) [ 4 – 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Esophageal Mucosal Calcinosis: A Rare Site of Gastrointestinal Mucosal Calcinosis

et al. 2018

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Patient: Male, 68Final Diagnosis: Esophageal mucosal calcinosisSymptoms: DysphagiaMedication: —Clinical Procedure: EsophagogastroduodenoscopySpecialty: Gastroenterology and HepatologyObjective:Rare co-existance of disease or pathologyBackground:Gastrointestinal tract mucosal calcinosis (MC) tends to affect the gastric mucosa, while esophageal involvement is rare. Gastric MC may be seen with solid organ transplantation, use of aluminum-containing antacids or sucralfate, malignancy, and chronic renal failure. While the incidence of gastric MC in renal transplant patients undergoing gastric biopsy is common (between 15–29%), to our knowledge esophageal MC has only been previously reported 3 times.Case Report:A 68-year-old male dialysis-dependent end stage renal disease status-post deceased donor kidney transplant underwent an esophagogastroduodenoscopy (EGD) for dysphagia and diffuse esophageal wall thickening seen on imaging studies. EGD demonstrated diffuse, circumferential thick white esophageal plaques and mucosal friability. Esophageal biopsies demonstrated erosive esophagitis with basophilic calcium deposits within the fibrinopurulent exudate and squamous mucosa. Stains for fungal organisms and viruses were negative. A diagnosis of esophageal MC was made. Although the patient had a protracted postoperative course after transplantation, he had improvement of the esophageal wall thickening on imaging after transplantation.Conclusions:Esophageal MC is a rare phenomenon and all of the previously reported cases of esophageal MC, including our case, have been in patients with end stage renal disease who were on dialysis. Although prolonged hypercalcemia and hyperphosphatemia, an elevated calcium-phosphorus product, and associated underlying inflammation are likely key etiologic factors, the pathogenesis of esophageal MC is not fully understood and is likely due to multiple collective etiologies. Likewise, more reported cases are likely to increase our understanding of the clinical significance and management of this rare disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Esophageal Mucosal Calcinosis: A Rare Site of Gastrointestinal Mucosal Calcinosis

et al. 2018

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“…If symptoms recur, the plan is for a placement of an SVC stent by interventional radiology. Notably, Garber et al just recently described a patient who presented with melena and dysphagia due to extraosseous calcification involving the esophagus in a 76-year-old woman with pertinent past medical history of diabetes mellitus type 2 complicated by end-stage renal disease (ESRD) on intermittent hemodialysis for 6 years with secondary hyperparathyroidism (12). Intravenous sodium thiosulfate has rapidly emerged from a seldom used therapy for the treatment of calciphylaxis to a treatment that is being increasingly utilized globally due to multiple positive outcomes shared in the form of case reports and reviews during the past six years (13).…”

Section: Discussionmentioning

confidence: 99%

Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation

Onuigbo¹,

Agbasi²,

Khan³

et al. 2017

J Parathyr Dis

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We described the unusual presentation of right unilateral facial swelling in a 48-year old end-stage renal disease (ESRD) male patient on maintenance hemodialysis following a failed kidney transplant. This was subsequently confirmed to be secondary to the extrinsic compression of the superior vena cava (SVC) by a large lobulated amorphous extra-osseous right axillary mass lesion that extended into the upper right thoracic outlet. Superior vena cava venogram and balloon angioplasty led to symptomatic relief. The factors involved in the pathogenesis of calciphylaxis are discussed and the available therapeutic options for this rare albeit debilitating disease are reviewed. Keywords: Calciphylaxis, Uremic arteriolopathy, Hemodialysis, Chronic kidney disease, Calcimimetics, End-stage renal disease Please cite this paper as: Onuigbo MAC, Khan A, Nijhawan V, Jiang Z. Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation J Parathyr Dis. 2018;6(2):68-71.

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“…The patient reported marked improvement in symptoms of dysphagia and improved oral intake, with eventual signs of weight gain after correcting his hyperphosphatemia, which corrected his calcium-phosphorus product to 35 mg 2 /dL. 2…”

Section: Answer To: Image 5: Calciphylaxis With Associated Esophagealmentioning

confidence: 94%

“…Esophagogastroduodenoscopy windings in each case were consistent, demonstrating friable mucosa with areas of erosion and ulceration. [2][3][4] Calciphlyaxis remains a highly morbid disease and treatment options are limited. Our patient was converted to hemodialysis, started on sodium thiosulfate thrice weekly, and started on proton pump inhibitors.…”

Section: Answer To: Image 5: Calciphylaxis With Associated Esophagealmentioning

confidence: 99%

Dysphagia in a Patient With End-Stage Renal Disease

Kirkpatrick

Salem

2018

Gastroenterology

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Question: A 65-year-old man with end-stage renal disease presented to the emergency department complaining of painful skin ulcers on his upper and lower extremities. The patient had been receiving peritoneal dialysis for the last 2 years, and he said that skin lesions developed 3 months prior. On further questioning, the patient described significant weight loss and 3 months of dysphagia to solids and liquids. On examination, the patient was cachectic and ill appearing with distal necrotic lesions of his upper and lower extremities with overlying eschars. His admission laboratory tests were significant for calcium of 6.8 mg/dL, phosphate of 12 mg/dL with a calcium-phosphorus product of 81.6 mg 2 /dL, 2 and alkaline phosphatase of 326 m/L. Esophagogastroduodenoscopy showed significant esophagitis with ulcerations throughout the length of the esophagus (Figure A, B). Biopsies taken during the esophagogastroduodenoscopy demonstrated prominent parakeratosis of the esophageal mucosa with calcium deposits in the subintimal layer (Figure C). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Extraosseous Calcification of the Esophagus: Clinicopathologic Correlates of Esophageal Mucosal Calcinosis

Cited by 4 publications

References 7 publications

Esophageal Mucosal Calcinosis: A Rare Site of Gastrointestinal Mucosal Calcinosis

Esophageal Mucosal Calcinosis: A Rare Site of Gastrointestinal Mucosal Calcinosis

Superior vena cava syndrome complicating calcific uremic arteriolopathy in an ESRD male patient on maintenance hemodialysis following failed kidney transplantation

Dysphagia in a Patient With End-Stage Renal Disease

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