Two Cases of Calciphylaxis Treated Successfully

Abstract

Case 1: A 68-year-old woman presented with a one-month history of a scratched ulcer on her right lower leg. She was on dialysis for chronic kidney disease of unknown cause for 19 years. She received a topical ointment by the previous physician ; however, the ulcer did not improve. Examination on admission revealed a walnut-sized skin ulcer with a bloody clot on the right lower leg. She complained of severe pain. The number and size of the ulcers gradually increased. Histopathology by Kossa staining demonstrated ring-shaped calcification on the wall of the small and medium arteries. A diagnosis of calciphylaxis was made. Case 2 : A 48-year-old woman was diagnosed with calciphylaxis by skin biopsy 5 months ago, and she was referred to the nephrology department of our hospital from the dermatology department of another hospital. She was on dialysis for 18 years because of IgA nephropathy. Examination on admission revealed a fist-sized ulcer on both thighs and severe pain was present. In each case, adjustment of the calcium (Ca) and phosphorus (P) levels, administration of sodium thiosulfate, and topical treatment were performed. In case 2, artificial dermis was applied after debridement. Successful epithelization was observed in both cases. In both cases, adjustment of the serum Ca and P levels, and intravenous injection of sodium thiosulfate were effective. Case 2 was the proximal type, but the lesion was localized and improvement was observed because sufficient debridement was performed. We consider it important to perform both systemic and surgical management for calciphylaxis. Skin Research, 19 : 127-132, 2020