Abstract
The patient was a woman in her 50s with type 2 diabetes and hypertension. She had pruritus and edema of both lower limbs from 1 month previously. She was hospitalized due to renal dysfunction. Cefazolin administration was started with the diagnosis of lower limb cellulitis, but she experienced heightened pain, and was referred to Dermatology department. At the first visit, erythematous livedoid purpura was observed in the area from the popliteal fossa of the bilateral lower limb to the ankle joint. The purpura was accompanied by strong tenderness and the induration. Blood test showed renal dysfunction and high parathyroid hormone levels. Contrast-enhanced computed tomography revealed that the bilateral femoral artery was meandering and calcified. Transthoracic echocardiography revealed calcification of the aortic valve, and parathyroid echography suspected parathyroid enlargement on the right lower polar dorsal side with hypoechoic mass. Calciphylaxis was diagnosed after skin biopsy showed calcification of small arteries in the adipose tissue. Dialysis induction with calcimimetics and administration of sodium thiosulfate during dialysis stopped the progression of necrosis and the ulcer slowly epithelialized. Debridement was performed only in the necrotic area and ointment treatment was administered, and all ulcers were epithelialized after 15 months. In the present case, administration of sodium thiosulfate was useful as an additional treatment for calciphylaxis that did not improve only by eliminating the cause and exacerbating factors such as anemia, electrolyte and parathyroid hormone abnormality.
