Severe nonuremic calciphylaxis due to hyperphosphatemia resolvingwith multimodality treatment including phosphate binders

摘要

Calciphylaxis is a highly morbid disease with a l-year mortality of approximately 80% that is usually associated with kidney disease.1 We report a case of nonuremic calciphylaxis in the setting of hyperphosphatemia that improved dramatically with phosphate binders and supportive care. Report of a Case | A white woman approximately 60 years old presented with numerous painful subcutaneous plaques and cutaneous necrosis, ulceration, and eschars on her hips, thighs, buttocks, abdomen, and breasts. She had a history of diabetes mellitus, congestive heart failure, tobacco abuse (half-pack of cigarettes daily), and endocarditis with artificial aortic valve replacement 7 years previously, requiring long-term warfarin treatment. Additional medications included aspirin, atorvastatin, furosemide, glimepiride, lisinopril, and meto-prolol. Her physical examination was remarkable for obesity (BMI, 32.3 [calculated as weight in kilograms divided by height in meters squared]) with firm, painful subcutaneous plaques on the lateral hips, thighs, buttocks, breasts, and abdomen. Overlying the plaques were large, angulated ulcerations with firm adherent black eschars and peripheral dusky erythema (Figure lA and B). Histopathologic analysis confirmed the diagnosis of calciphylaxis (Figure 2).