A rare presentation of calciphylaxis in normal renal function

Introduction: Calciphylaxis is a rare and lifethreatening condition in which extensive microvascular calcification in arterioles and occlusion of vessels lead to painful non-healing ulcers with high mortality rate. Calciphylaxis is mainly associated with end stage renal disease or hyperparathyroidism, with rare cases reported in cirrhosis patient. Case Report: A 55-year-old Caucasian male with significant history of porphyria cutanea tarda and Hepatitis C complicated by cirrhosis with normal renal function presents with history of non-healing ulcers on both of his hands. The diagnosis of calciphylaxis was made by X-ray. Due to rapid progression of the ulcers to tissue necrosis and gangrene with no definite underlying pathology, the patient’s hands were eventually amputated due to the inability to withstand pain. Conclusion: Patients presenting with painful ulceration of their fingers with history of cirrhosis and normal renal function should be worked up for calciphylaxis as part of the differential diagnosis, especially with low serum albumin level. Site of calciphylaxis also matters as there is a great difference between mortality rates of proximal versus distal. We postulate the idea of pathophysiological mechanism with further research needed. This case report should alert physicians that calciphylaxis does occurred in patients with cirrhosis and normal renal function. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 6, June 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(6):366–369. www.ijcasereportsandimages.com Rimtepathip et al. 366 CASE REPORT OPEN ACCESS A rare presentation of calciphylaxis in normal renal function Parin Rimtepathip, David Cohen