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ClinicalA 49-year-old male with end stage renal disease (ESRD) on haemodialysis was referred for further management of painful, extensive bilateral lower extremity ulcerations present for 8 months (Figure 1). Figure 1. Lower extremity ulceration and overlying eschar Significant labs were leukocytosis, elevated calcium-phosphorus product (CaxP) of 97.5 mg2/dl2 and parathyroid hormone (PTH) level of 3708 pg/ml (10-60). Biopsy of the cutaneous lesions revealed epidermal and dermal necrosis, thrombosis and calcifications in small blood vessels of subcutis (Figure 2). Figure 2. (A) Skin biopsy showing dermal necrosis with neutrophilic infiltration, subcutaneous arterial vessel with thrombosis, marked intimal proliferation and near circumferential calcification causing occlusion of the lumen. H&E magnification 00d7100; (B) Inset showing the thrombosed vessel with circumferential calcification in the vessel wall (black arrows). H&E magnification 00d7400 What is the diagnosis? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Manchanda Aarti, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Punj Shweta, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Sharma Ankur, MD, Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA; Beeravolu Swathi, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Jinxing Jiang, MD, Department of Pathology, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Babu Ambika, MD, Department of Endocrinology, John H Stroger Jr. Hospital of Cook County, Illinois, USA

Acknowledgements

Correspondence

mbika Babu MD, MS. 1900 West Polk Street, Suite 805, Chicago, IL 60612.

Correspondence Email

Ambika_Babu@rush.edu

Competing Interests

Mazhar AR, Johnson RJ, Gillen D, et al. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney International 2001;60(1):324-332.Riegert-Johnson DL, Kaur JS, Pfeifer EA. Calciphylaxis associated with cholangiocarcinoma treated with low molecular-weight heparin and vitamin K. Mayo Clin Proc 2001;76:749-52.Ozbalkan Z, Calguneri M, Onat AM, Ozturk MA. Development of calciphylaxis after long-term steroid and methotrexate use in a patient with rheumatoid arthritis. Ann Intern Med 2005;44:1178-81.Vincent M. Brandenburg MC, Ketteler M. Calciphylaxis: a still unmet challenge.. Journal of Nephrology 2011;24(2):142-148.Bishop J, Brown E, Podesta A, et al. Surgical management of calciphylaxis associated with primary hyperparathyroidism: A case report and review of the literature. International Journal of Endocrinology 2010, Article ID 823210, doi:10.1155/2010/823210. http://www.hindawi.com/journals/ije/2010/823210/

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ClinicalA 49-year-old male with end stage renal disease (ESRD) on haemodialysis was referred for further management of painful, extensive bilateral lower extremity ulcerations present for 8 months (Figure 1). Figure 1. Lower extremity ulceration and overlying eschar Significant labs were leukocytosis, elevated calcium-phosphorus product (CaxP) of 97.5 mg2/dl2 and parathyroid hormone (PTH) level of 3708 pg/ml (10-60). Biopsy of the cutaneous lesions revealed epidermal and dermal necrosis, thrombosis and calcifications in small blood vessels of subcutis (Figure 2). Figure 2. (A) Skin biopsy showing dermal necrosis with neutrophilic infiltration, subcutaneous arterial vessel with thrombosis, marked intimal proliferation and near circumferential calcification causing occlusion of the lumen. H&E magnification 00d7100; (B) Inset showing the thrombosed vessel with circumferential calcification in the vessel wall (black arrows). H&E magnification 00d7400 What is the diagnosis? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Manchanda Aarti, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Punj Shweta, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Sharma Ankur, MD, Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA; Beeravolu Swathi, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Jinxing Jiang, MD, Department of Pathology, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Babu Ambika, MD, Department of Endocrinology, John H Stroger Jr. Hospital of Cook County, Illinois, USA

Acknowledgements

Correspondence

mbika Babu MD, MS. 1900 West Polk Street, Suite 805, Chicago, IL 60612.

Correspondence Email

Ambika_Babu@rush.edu

Competing Interests

Mazhar AR, Johnson RJ, Gillen D, et al. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney International 2001;60(1):324-332.Riegert-Johnson DL, Kaur JS, Pfeifer EA. Calciphylaxis associated with cholangiocarcinoma treated with low molecular-weight heparin and vitamin K. Mayo Clin Proc 2001;76:749-52.Ozbalkan Z, Calguneri M, Onat AM, Ozturk MA. Development of calciphylaxis after long-term steroid and methotrexate use in a patient with rheumatoid arthritis. Ann Intern Med 2005;44:1178-81.Vincent M. Brandenburg MC, Ketteler M. Calciphylaxis: a still unmet challenge.. Journal of Nephrology 2011;24(2):142-148.Bishop J, Brown E, Podesta A, et al. Surgical management of calciphylaxis associated with primary hyperparathyroidism: A case report and review of the literature. International Journal of Endocrinology 2010, Article ID 823210, doi:10.1155/2010/823210. http://www.hindawi.com/journals/ije/2010/823210/

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

ClinicalA 49-year-old male with end stage renal disease (ESRD) on haemodialysis was referred for further management of painful, extensive bilateral lower extremity ulcerations present for 8 months (Figure 1). Figure 1. Lower extremity ulceration and overlying eschar Significant labs were leukocytosis, elevated calcium-phosphorus product (CaxP) of 97.5 mg2/dl2 and parathyroid hormone (PTH) level of 3708 pg/ml (10-60). Biopsy of the cutaneous lesions revealed epidermal and dermal necrosis, thrombosis and calcifications in small blood vessels of subcutis (Figure 2). Figure 2. (A) Skin biopsy showing dermal necrosis with neutrophilic infiltration, subcutaneous arterial vessel with thrombosis, marked intimal proliferation and near circumferential calcification causing occlusion of the lumen. H&E magnification 00d7100; (B) Inset showing the thrombosed vessel with circumferential calcification in the vessel wall (black arrows). H&E magnification 00d7400 What is the diagnosis? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Manchanda Aarti, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Punj Shweta, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Sharma Ankur, MD, Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA; Beeravolu Swathi, MD, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Jinxing Jiang, MD, Department of Pathology, John H Stroger Jr. Hospital of Cook County, Illinois, USA; Babu Ambika, MD, Department of Endocrinology, John H Stroger Jr. Hospital of Cook County, Illinois, USA

Acknowledgements

Correspondence

mbika Babu MD, MS. 1900 West Polk Street, Suite 805, Chicago, IL 60612.

Correspondence Email

Ambika_Babu@rush.edu

Competing Interests

Mazhar AR, Johnson RJ, Gillen D, et al. Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney International 2001;60(1):324-332.Riegert-Johnson DL, Kaur JS, Pfeifer EA. Calciphylaxis associated with cholangiocarcinoma treated with low molecular-weight heparin and vitamin K. Mayo Clin Proc 2001;76:749-52.Ozbalkan Z, Calguneri M, Onat AM, Ozturk MA. Development of calciphylaxis after long-term steroid and methotrexate use in a patient with rheumatoid arthritis. Ann Intern Med 2005;44:1178-81.Vincent M. Brandenburg MC, Ketteler M. Calciphylaxis: a still unmet challenge.. Journal of Nephrology 2011;24(2):142-148.Bishop J, Brown E, Podesta A, et al. Surgical management of calciphylaxis associated with primary hyperparathyroidism: A case report and review of the literature. International Journal of Endocrinology 2010, Article ID 823210, doi:10.1155/2010/823210. http://www.hindawi.com/journals/ije/2010/823210/

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