Pulmonary Calciphylaxis Associated with Acute Respiratory and Renal Failure Due to Cryptogenic Hypercalcemia: An Autopsy Case Report

Abstract

Metastatic calcification is rare; it is found during autopsy in patients who underwent hemodialysis. Diffuse calcium precipitation of small and medium-sized cutaneous vessels, known as calciphylaxis, can result in progressive tissue necrosis secondary to vascular calcification. This condition most commonly involves the skin; however, a rare occurrence of visceral calciphylaxis has been reported. Here we report on an autopsy case. Despite a thorough evaluation, and even performing an autopsy, the underlying cause of acute-onset hypercalcemia, resulting in the production of pulmonary calciphylaxis and metastatic renal calcification associated with acute respiratory and renal failure, could not be determined. Metastatic calcification often lacks specific symptoms, and the degree of calcification is a marker of the severity and chronicity of the disease. This unusual autopsy case emphasizes the importance of rapidly progressing visceral calciphylaxis, as well as its early detection.

Calciphylaxis: from the disease to the diseased

“…Painting the clinical picture and ruling out differential diagnoses Due to the clinical heterogeneity of CUA in both uremic and non-uremic patients, subgroups of the disease with distinct prognoses have been proposed [20,39]. Skin involvement is more frequent; rare cases of CUA affecting internal organs have also been described [52].…”

“…Visceral CUA has been identified in post-mortem examinations of critically ill patients. Reported clinical presentations include acute respiratory failure [52,53], gastrointestinal bleeding [54] and widespread visceral involvement in a patient with primary autoimmune myelofibrosis [51]. A recent investigation has questioned the actual existence of non-cutaneous CUA, pointing the lack of definitive histopathologic evidence in some of these autopsy cases [55].…”

Acute Respiratory Distress Syndrome Induced by Parathyroid Storm

“…It is regarded as a systemic disease but, almost always, skin, subcutaneous fat or muscles of extremities are involved resulting in ulcerations. Nonetheless, visceral calciphylaxis has been described with diffuse tissue calcification which affects lungs, myocardium, kidneys or even pancreas [ 14 , 17 , 19 ]. Regarding our patient, the development of CUA cannot be excluded, since tissue biopsies were not obtained and autopsy was not performed.…”

A rare case report of multiple myeloma presenting with paralytic ileus and type II respiratory failure due to hypercalcemic crisis

“…We considered that the respiratory failure was attributable to respiratory muscle paralysis or pulmonary calciphylaxis secondary to hypercalcemia. [14]…”