Penile calciphylaxis

Abstract

53-year-old man with history of hypertension, type 2 diabetes, peripheral vascular disease, and end-stage renal disease on continuous cycling peritoneal dialysis presented to the emergency department with generalized weakness and found to have findings concerning for severe sepsis. Vital signs on presentation: T-max 35.7 C, BP 92/59 mm Hg, HR 97 per minutes, and RR 25 per minutes. Physical examination revealed painful blackish necrotic discoloration of the perimeatal tissues and ventral side of glans penis with no evidence of infection as shown in Figure 1. Urology was consulted and recommended supportive care with local wound care for presumed penile calciphylaxis. Biopsy was discussed but deferred due to high likelihood that the biopsy site will never heal and will lead to further decline. Laboratories revealed serum calcium 9.6 mg/dL, serum phosphorus 6.7 mg/dL, and PTH 163 pg/mL and elevated WBCs 19.2 ×10(3) cells/mcL. With the presumptive diagnosis of penile Calciphylaxis, CTA pelvis was taken, revealing extensive calcification of penile vasculature. The patient was treated with broad-spectrum IV antibiotics, switched to hemodialysis, received adequate wound care, pain control, aggressive phosphorus control, and lower dialysate calcium with palliative care to improve quality of life. On follow up, patient is getting better with resolution of skin ulcers and improvement of pain symptoms. Calciphylaxis or calcific uremic arteriolopathy is a syndrome characterized by calcification of vessels located in the dermis and adipose tissue. It commonly occurs in patients with end-stage renal disease, diabetes mellitus, hypertension, and obesity. 1 Penile involvement is an uncommon but severe manifestation. Pathologic evaluation should be used

Uremic Bilateral Breast Calciphylaxis: A Case Report and Literature Review

“…In addition to the skin and subcutaneous tissue of the limbs, trunk, and buttocks, calciphylaxis as a systemic disease also affects the deeper organs, including the kidneys, lungs, brain, heart, and gastrointestinal tract. It is less frequently encountered in the penis, eyes, and breasts [ 2 , 8 , 9 ]. Calciphylaxis is usually associated with end-stage kidney disease, where patients are on long-term renal dialysis with subsequent secondary hyperparathyroidism.…”

Challenges management in penile calciphylaxis

“…Penile calciphylaxis is a rare condition that is a severe manifestation associated with poor prognosis and high mortality rate. 3 Most patients who have penile involvement are aged between 40 and 60 years. Diagnosis is challenging at the early phase because patients have only penile pain without skin lesion; therefore, physicians should be more suspicious of this disease in patients with ESRD presenting with painful penis.…”