Discovering implicit associations in a case of encapsulating peritoneal sclerosis complicated by severe mineral imbalance

BMJ Case Rep. 2014 Nov 3:2014:bcr2014206195. doi: 10.1136/bcr-2014-206195.

Abstract

We describe the case of a 42-year-old woman who developed encapsulating peritoneal sclerosis (EPS) after 7 years on peritoneal dialysis, with clinical relief by enterolysis associated to treatment with tamoxifen, corticosteroids and parenteral nutrition in haemodialysis. During the next 7 months, she was also conservatively stabilised for mild hyperparathyroidism until she was admitted with calciphylaxis, associated with massive extraosseous calcification. Despite parathyroidectomy and sodium thiosulfate treatment, which resulted in a successful resolution of calciphylaxis, she died 1 year later due to a gross calcified peritoneum. In view of controlled hyperparathyroidism, the massive extraosseous calcification beginning after EPS diagnosis furthermore corroborates a recently suggested role for calcium-regulatory factors associated with poor outcome in EPS.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Calciphylaxis / complications*
  • Calciphylaxis / drug therapy
  • Fatal Outcome
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Hyperparathyroidism / complications
  • Hyperparathyroidism / drug therapy
  • Parathyroidectomy / methods
  • Parenteral Nutrition, Total / methods
  • Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
  • Peritoneal Fibrosis / complications*
  • Peritoneal Fibrosis / drug therapy
  • Peritoneum / diagnostic imaging
  • Peritoneum / pathology
  • Tamoxifen / therapeutic use
  • Thiosulfates / therapeutic use
  • Tomography, X-Ray Computed / methods

Substances

  • Glucocorticoids
  • Thiosulfates
  • Tamoxifen
  • sodium thiosulfate