UMEM Educational Pearls

Category: Critical Care

Title: Calciphylaxis

Posted: 11/30/2009 by Evadne Marcolini, MD (Emailed: 12/1/2009) (Updated: 1/18/2022)
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Calciphylaxis is a rare disorder caused by systemic arteriolar calcification which leads to ischemia and necrosis.  It is characterized by painful ischemic necrotic lesions on adipose tissue areas such as abdomen, buttock and thighs.  This commonly occurs in patients with ESRD on hemodialysis or after transplant, but can also occur with other patients, such as those with hyperparathyroidism.

Diagnosis is made clinically, with the help of a skin biopsy as needed.  Differential diagnosis includes cholesterol embolization, warfarin necrosis, cryoglobulinemia, cellulitis and vasculitis.  There are no specific laboratory findings, although patients may manifest elevated PTH, phosphorous, calcium or calcium x phosphorous product. 

Infection is usually the cause of the high mortality rate of this condition, which has a reported mortality of 46%, or 80% if ulceration is present.

Treatment includes local wound care, trauma avoidance, electrolyte correction, increased frequency of dialysis or parathyroidectomy as needed.  Surgical debridement is controversial; as the risk of infection may outweigh the benefit in terms of outcome. 

References

Reference: Santos, et al: Uptodate.com