Case report
Successful treatment of calciphylaxis with intravenous sodium thiosulfate

https://doi.org/10.1053/j.ajkd.2004.03.018Get rights and content

Abstract

Calciphylaxis is a dreaded complication of renal failure characterized by nodular subcutaneous calcification and painful tissue necrosis often leading to ulceration, secondary infection, and high mortality rates. The case of a woman receiving continuous ambulatory peritoneal dialysis who had a typical clinical presentation of calciphylaxis confirmed by x-ray and technetium scan findings is described. After nonresponse to conventional therapy, treatment with intravenous sodium thiosulfate 3 times weekly was begun, and she had rapid and dramatic relief of signs and symptoms and improvement of technetium scans. Prolonged treatment was well tolerated without serious side effects and accompanied by continued clinical improvement.

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Case report

A 69-year-old white woman with a medical history including coronary artery disease, renal calculi, obesity, osteoarthritis, Graves disease, osteoporosis, and a long history of hypertension presented in 1999 with renal disease due to by hypertension and chronic hydronephrosis caused by retained ureteral calculi. Renal failure progressed, and in April 2002 the patient was started on continuous ambulatory peritoneal dialysis (CAPD). Peritoneal dialysate Ca concentration was 3.5 mEq/L (mmol/L). She

Discussion

Our patient had debilitating calciphylactic lesions 4 months after beginning peritoneal dialysis. The clinical setting, patient characteristics, signs and symptoms, and progression of the lesions were all characteristic of calciphylaxis,3, 4, 9, 10 as were the x-ray4 and bone scan findings.4 Biopsy specimens of calciphylactic lesions show calcification and endovascular fibrosis of small subcutaneous arteries and arterioles, often associated with infarction of the adjacent subcutis and skin. We

Acknowledgements

The authors thank Patricia King, David Kurniawan, and Danielle Napoles, RN, for their assistance in preparing the manuscript and in helping care for the patient.

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