Nonuremic Calciphylaxis Associated With Hypercalcemia and Rheumatologic Diseases

Athip Vatanapradith; Ashwini Pujari; Phani Morisetti; Samina Hayat; Kenneth Abreo; Bakhtiar M Amin

doi:10.1016/j.xkme.2021.04.024

Nonuremic Calciphylaxis Associated With Hypercalcemia and Rheumatologic Diseases

Kidney Med. 2021 Jul 13;3(5):856-859. doi: 10.1016/j.xkme.2021.04.024. eCollection 2021 Sep-Oct.

Authors

Athip Vatanapradith¹, Ashwini Pujari¹, Phani Morisetti², Samina Hayat³, Kenneth Abreo², Bakhtiar M Amin²

Affiliations

¹ Department of Internal Medicine, Louisiana State University Health Science Center, Shreveport, Louisiana.
² Department of Nephrology, Louisiana State University Health Science Center, Shreveport, Louisiana.
³ Department of Rheumatology, Louisiana State University Health Science Center, Shreveport, Louisiana.

Abstract

Calcific uremic arteriolopathy, termed calciphylaxis, was previously considered a condition that developed mostly in patients requiring dialysis. It has now been described in kidney transplant patients, in advanced chronic kidney disease (CKD) patients not requiring dialysis, and in individuals with maintained kidney function. We describe an individual with CKD stage 3b with hypercalcemia who presented with features highly specific for calciphylaxis based on results of a skin biopsy. The condition has high morbidity and mortality, and thus prompts immediate cessation of the offending agents or treatment of the cause. The following case and literature review demonstrates a need for a detailed assessment of patients' risks and exposures and expanding the differential diagnosis to include calciphylaxis in nonuremic patients with necrotic ulcers with a plan for early imaging and possible biopsy.

Keywords: Nonuremic calciphylaxis; Sjögren syndrome; calcific uremic arteriolopathy; case report; hypercalcemia; kidney disease; rheumatoid arthritis; vitamin D intoxication.

Publication types

Case Reports