Successful treatment of severe calciphylaxis in a renal transplant patient with previous total parathyroidectomy

Abstract

Calciphylaxis is a rare dermatological condition strongly associated with chronic kidney disease. The clinical course can be devastating, with high associated morbidity and mortality. The pathophysiology and optimum treatment remain uncertain. Calciphylaxis is known mostly to affect dialysis patients but is less frequently reported in renal transplant recipients. We report the case of a renal transplant recipient who had undergone previous total parathyroidectomy. Diagnosis was made at the time of limb amputation, yet despite this relatively late diagnosis she made a good recovery. We believe this resulted from a multi-modal approach including surgical debridement, sodium thiosulphate and vitamin K2 therapy. She remained free from recurrence 2 years after completion of treatment, despite on-going vitamin D replacement. There is much still to ascertain regarding calciphylaxis treatment, including the optimal regimens and duration of therapy, particularly in the transplant recipient population where data are limited.