Metastatic calcification with skin necrosis

Golitz, L. E.

doi:10.1001/archderm.106.3.398

Cited by 9 publications

(13 citation statements)

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“…The majority of the cases had normal serum calcium (58%), normal serum phosphorous (69.4%), normal calcium phosphorous product (72.2%), and low or normal serum parathyroid hormone levels (50%). Marked elevation in serum calcium (equivalent to Ͼ12 mg/dl) was seen in six cases (17,19,21,22,34), and marked serum phosphorous elevations were seen in only two cases (3,15). Elevation of calcium-phosphorous product Ͼ50 was seen in only seven cases (3,7,17,19,21,22,33).…”

Section: Resultsmentioning

confidence: 96%

“…Marked elevation in serum calcium (equivalent to Ͼ12 mg/dl) was seen in six cases (17,19,21,22,34), and marked serum phosphorous elevations were seen in only two cases (3,15). Elevation of calcium-phosphorous product Ͼ50 was seen in only seven cases (3,7,17,19,21,22,33). Among patients who had primary hyperparathyroidism as a cause of NUC, serum parathyroid hormones were elevated to between 1.5 to 2.0 times the upper limit of normal range, unlike in patients with CUA, in whom serum parathyroid hormone levels are frequently elevated three to four times the upper limit of normal range.…”

Section: Resultsmentioning

confidence: 96%

“…These included 27 individual case reports (3,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32) and four case series (4,6,26,33). A summary of the literature search strategy is provided in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Primary hyperparathyroidism (4,7,19,24,27,29,33), connective tissue diseases (6,20,28), alcoholic liver disease (9,11,13,14,16,22), and malignancies (5,15,17,21,23,30,31) were the most common causes of NUC (Table 1). Diabetes (26), chemotherapy-induced (cyclophosphamide, Adriamycin, and fluorouracil) protein C and S deficiency (18), Crohn disease (3), POEMS syndrome (12), vitamin D deficiency (10), weight loss (25), chronic kidney disease (not ESKD) (32), and osteomalacia treated with nadroparin calcium (8) were the remaining reported etiologic conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Reported treatments included supportive wound care with pain control, empiric antibiotic therapy, treating underlying etiologic conditions (e.g., parathyroidectomy for patients with hyperparathyroidism), and removing potential precipitating factors (e.g., corticosteroids, albumin infusions). Vitamin D supplementation as treatment was given in three cases (6,24), and inorganic intravenous phosphorous was administered in one case (17). Systemic corticosteroids were used in the treatment of NUC in five cases Cholangiocarcinoma, chronic myelocytic leukemia, malignant melanoma, metastatic breast cancer, and multiple myeloma; includes one case of metastatic parathyroid carcinoma causing primary hyperparathyroidism.…”

Section: Resultsmentioning

confidence: 99%

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Calciphylaxis from Nonuremic Causes

Nigwekar

Wolf²,

Sterns

et al. 2008

Clinical Journal of the American Society of Nephrology

370

396

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Background and objectives: Calciphylaxis, or calcific uremic arteriolopathy, is a well-described entity in end-stage kidney disease and renal transplant patients; however, little systematic information is available on calciphylaxis from nonuremic causes. This systematic review was designed to characterize etiologies, clinical features, laboratory abnormalities, and prognosis of nonuremic calciphylaxis.Design, setting, participants, & measurements: A systematic review of literature for case reports and case series of nonuremic calciphylaxis was performed. Cases included met the operational definition of nonuremic calciphylaxis-histopathologic diagnosis of calciphylaxis in the absence of end-stage kidney disease, renal transplantation, or acute kidney injury requiring renal replacement therapy.Results: We found 36 cases (75% women, 63% Caucasian, aged 15 to 82 yr) of nonuremic calciphylaxis. Primary hyperparathyroidism, malignancy, alcoholic liver disease, and connective tissue disease were the most common reported causes. Preceding corticosteroid use was reported for 61% patients. Protein C and S deficiencies were seen in 11% of patients. Skin lesions were morphologically similar to calcific uremic arteriolopathy. Mortality rate was 52%, with sepsis being the leading cause of death.Conclusion: Calciphylaxis should be considered while evaluating skin lesions in patients with predisposing conditions even in the absence of end-stage kidney disease and renal transplantation. Nonuremic calciphylaxis is reported most often in white women. Mineral abnormalities that are invoked as potential causes in calcific uremic arteriolopathy are often absent, suggesting that heterogeneous mechanisms may contribute to its pathogenesis. Nonuremic calciphylaxis is associated with high mortality, and there is no known effective treatment.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Calciphylaxis from Nonuremic Causes

Nigwekar

Wolf²,

Sterns

et al. 2008

Clinical Journal of the American Society of Nephrology

370

396

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Calciphylaxis With Normal Renal and Parathyroid Function

Kalajian¹,

Malhotra²,

Callen³

et al. 2009

Arch Dermatol

105

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Background: Calciphylaxis is a life-threatening form of metastatic calcification-induced microvascular occlusion syndrome. Although traditionally observed in patients with end-stage renal disease and/or hyperparathyroidism, the development of calciphylaxis in "nontraditional" patients having both normal renal and parathyroid function has been reported. However, to date there has been no collective analysis identifying common patient characteristics potentially predisposing to the development of calciphylaxis in nontraditional patients.Observations: A 58-year-old woman with endometrial carcinoma developed extensive calciphylaxis despite the presence of normal renal and parathyroid function. The disease resolved with rapid diagnosis, supportive therapy, and medical management. Analysis of this case and the 13 previously reported cases of nontraditional calciphylaxis identified the following patient characteristics that highlight clinical situations potentially predisposing to calciphylaxis: hypoalbuminemia, malignant neoplasm, systemic corticosteroid use, anticoagulation with warfarin sodium or phenprocoumon, chemotherapy, systemic inflammation, hepatic cirrhosis, protein C or S deficiency, obesity, rapid weight loss, and infection.Conclusions: Calciphylaxis is becoming increasingly common in patients with normal renal and parathyroid function. The observations from this study may assist dermatologists in the rapid diagnosis and prompt initiation of therapy for this devastating disease.

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