Calciphylaxis in Hemodialysis Patients: Diagnosis and Treatment about a Case

Abstract

Calciphylaxis is a condition that causes cutaneous necrosis, which primarily affects patients with end-stage renal disease undergoing dialysis. Histologically, this condition is characterized by subintimal calcific deposits in small-caliber arteries, leading to luminal obstruction. Unlike medial calcification, which affects the media of arteries, calciphylaxis affects the intima of arterioles. Early diagnosis and appropriate management, including addressing the underlying cause, can improve the poor prognosis associated with this condition. In this case report, a 59-year-old woman with end-stage diabetic nephropathy and chronic kidney disease on hemodialysis presented with large, painful, ulcerated lesions on the inner aspects of both knees that were shallow and showed no signs of bacterial superinfection. Hypercalcemia was noted on biochemical analysis, and radiographs of the thighs revealed vascular calcifications of the superficial femoral, popliteal, and leg arteries bilaterally. Histological examination revealed dermal neovascularization with stasis thrombi and secondary epidermal necrosis, indicating an underlying thromboembolic phenomenon. The management consisted of analgesic treatment and daily local care, along with intensified dialysis sessions with sodium thiosulfate and rheopheresis. A marked improvement in the patient's condition was observed following an accidental occurrence of resolving gas embolism after hyperbaric oxygen therapy, which played a significant role in the regression of cutaneous necrosis. Therefore, hyperbaric oxygenation may be considered as a potential treatment option for calciphylaxis.