Skin ulcers triggered by calciphylaxis in hemodialysis patients: Two case reports

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  • Fukunaga Shin
    Japan Community Health care Organization Miyazaki Konan Hospital
  • Baba Akiko
    Japan Community Health care Organization Miyazaki Konan Hospital
  • Tokura Ken
    Japan Community Health care Organization Miyazaki Konan Hospital
  • Yamada Kazuhiro
    Japan Community Health care Organization Miyazaki Konan Hospital
  • Sato Yuji
    Dialysis Division, University of Miyazaki Hospital
  • Fujimoto Shouichi
    Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki

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Other Title
  • カルシフィラキシスによる皮膚潰瘍を呈した血液透析患者の2例
  • 症例報告 カルシフィラキシスによる皮膚潰瘍を呈した血液透析患者の2例
  • ショウレイ ホウコク カルシフィラキシス ニ ヨル ヒフ カイヨウ オ テイシタ ケツエキ トウセキ カンジャ ノ 2レイ

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<p>Case 1: This case involved a 43-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 5 years). She was admitted to our hospital to undergo treatment for right foot gangrene. At the time of her hospitalization, we detected multiple painful nodules on her abdominal region, which gradually progressed to multiple painful skin ulcers. The diagnosis was made based on a skin biopsy, which showed the typical findings of calciphylaxis (annular calcium deposition in the media of the small arteries). She was treated by adjusting her calcium (Ca) and phosphorus (P) levels and administering topical treatment and intravenous antibiotics; however, she ultimately died of sepsis. Case 2: This case involved a 42-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 3 years). She was admitted to our hospital to undergo treatment for an intractable skin ulcer of the left toe. The diagnosis was made based on the pathological findings of a sample obtained during a local operation, which showed the typical findings of calciphylaxis. She was treated by discontinuing her warfarin therapy, adjusting her Ca and P levels, and administering topical treatment. Thereafter, her calciphylaxis lesion successfully improved. Calciphylaxis is a potentially fatal complication of end-stage renal disease and is characterized by medial calcification and intimal proliferation of the small arteries. Given that calciphylaxis is a rare disease, it is not easily recognized. However, calciphylaxis can cause intractable skin ulcers, so it should be considered during the differential diagnosis of hemodialysis patients with skin ulcers.</p>

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