2018 Research Forum

Calciphylaxis (Calcific uremic arteriolopathy) in an ESRD patient Presenter & Principal Investigator: Addie Bugas MD Faculty Sponsor: Daniel Quesada MD Addie Bugas MD 1 , Daniel Quesada MD 2 , Phillip Aguiñiga-Navarrete 3 1 Resident Physician R3 2 Emergency Medicine Faculty; Health Sciences Assistant Clinical Professor, David Geffen School of Medicine at UCLA 3 Emergency Medicine Research Assistant Program INTRODUCTION A condition with a high mortality rate, calciphylaxis is a rare and dire complication of chronic renal failure characterized by vascular calcium overload. We present a case of systemic calciphylaxis with deep vascular and dermal complicity. Photographic signed consent was obtained from the patient, including IRB approval for the case report. PURPOSE 38-year-old male with a past medical history of uncontrolled DMT2, HTN, and ESRD, not on dialysis, presented to our facility with two weeks of SOB, productive cough, bilateral lower extremity edema, diffuse rash on upper and lower extremities and severe penile pain and dysuria. DISCUSSION Calciphylaxis was once thought to be a rare complication of ESRD, but is becoming more common, possibly secondary to increased recognition of symptoms. Optimal treatment is not yet known, but some treatment pathways include sodium thiosulfate and non-calcium-containing phosphate binders such as sevelamer, cinacalcet, for patients with elevated PTH, hyperbaric oxygen and sterile maggot therapy. Pathophysiology is not fully understood; though clinical manifestations result from reduction in arteriolar blood flow. Medial vessel calcification occurs first. Ongoing vascular endothelial injury results in cutaneous arteriolar narrowing and hypercoagulable state that cause tissue infarction. Deep vascular involvement will subsequently lead to limb ischemia. CONCLUSION Calciphylaxis was once considered to be a rare complication of ESRD, but has become more common, possibly secondary to increased recognition of symptoms. In this case, findings incorporated arteriolar calcifications resulting in necrotic skin lesions including deep vascular calcifications that were identified easily with plain film. Clinical suspicion of calciphylaxis must remain high in ESRD as early diagnosis and intervention can help prevent amputation.

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