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Martí Pelluch CC, Soler Sendra A, Vila Vall-Llovera M. Non-uremic calciphylaxis: case series. Med Clin (Barc) 2023; 160:318-319. [PMID: 36473774 DOI: 10.1016/j.medcli.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Anna Soler Sendra
- Servicio de Medicina Interna, Hospital General de Granollers, Granollers, Barcelona, España
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Virkkala J, Polet S, Jokelainen J, Huilaja L, Sinikumpu S. Clinical characteristics and comorbidities of the most common atypical wounds in Northern Finland in 1996-2019: A retrospective registry study. Health Sci Rep 2022; 5:e864. [PMID: 36189416 PMCID: PMC9511497 DOI: 10.1002/hsr2.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Atypical wounds comprise about 20% of all chronic wounds. Their diagnosis and treatment are challenging and require multidisciplinary cooperation. More knowledge is needed about the clinical characteristics and comorbidities of atypical wounds to enhance the treatment of these wounds. Methods We studied clinical characteristics and comorbidities of the atypical wounds by using the patient data retrieved from the Oulu University Hospital patient database from the year 1996 to the end of 2019 with the following International Classification of Diseases codes: L88, L95.0, L95.8, L95.9, and L98.1. Results In our data, there were 135 patients with atypical wound, more commonly seen in females (N = 84, 62.2%) than in males (N = 51, 37.8%) (p < 0.05). The mean age of patients at the time of diagnosis was 57.3 years; those with pyoderma gangrenosum (PG) and factitious wounds were the youngest (53.1 and 53.0 years, respectively). The majority of subjects (N = 126, 93.3%) were diagnosed with comorbidity at the time of the diagnosis. The most common type of wound was PG (N = 49/135, 36.3%), followed by vasculitis and factitious wounds. The prevalence of inflammatory bowel diseases and rheumatoid arthritis in PG patients was high (18.4% for both). All patients with Martorell hypertensive ischemic leg ulceration/calciphylaxis had a diagnosis of hypertension and diabetes mellitus. Psychiatric diseases were more common in patients with factitious wounds than in other types of wounds, whereas patients with vasculitis wounds had more commonly hypertension, obesity, and diabetes mellitus; however, these did not reach statistical significance. Conclusion Specific comorbidities associated with atypical wounds, such as high psychiatric comorbidity in factitious wounds. There is a female predominance in atypical wounds and patients are typically younger than patients with other types of wounds. Recognition of the typical clinical picture and comorbidities of atypical wounds may help in identifying these patients and thus also improving their treatment.
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Affiliation(s)
| | - Sara Polet
- Faculty of MedicineUniversity of OuluOuluFinland
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of MedicineUniversity of OuluOuluFinland
| | - Laura Huilaja
- PEDEGO Research Unit, Department of Dermatology and Medical Research Center Oulu, Oulu University HospitalUniversity of OuluOuluFinland
| | - Suvi‐Päivikki Sinikumpu
- PEDEGO Research Unit, Department of Dermatology and Medical Research Center Oulu, Oulu University HospitalUniversity of OuluOuluFinland
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AlQattan AS, Ghulam WZ, Aldaoud N, Algheryafi L, Aleisa N, Aldulaijan FA. Breast fat necrosis secondary to warfarin-induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature. Breast J 2021; 27:258-263. [PMID: 33480097 DOI: 10.1111/tbj.14160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small- and medium-sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic-induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin-induced calciphylaxis. We report a 65-year-old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4-month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10-2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis-induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin-induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow-up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end-stage kidney disease.
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Affiliation(s)
- Abdullah Saleh AlQattan
- Department of Surgery, Breast and Endocrine Surgery Section, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Weaam Zohier Ghulam
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, Saudi Arabia
| | - Najla Aldaoud
- Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan.,Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Lama Algheryafi
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Nadia Aleisa
- Department of Radiology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fozan A Aldulaijan
- Department of Surgery, Breast and Endocrine Surgery Section, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
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Nonuraemic calciphylaxis: A case series. Ann Dermatol Venereol 2021; 148:127-129. [PMID: 33461791 DOI: 10.1016/j.annder.2020.09.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 09/22/2020] [Indexed: 11/21/2022]
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Afridi SM, Raja A, Zhou X, Jain A. Calciphylaxis due to metastatic well-differentiated neuroendocrine carcinoma. BMJ Case Rep 2019; 12:12/8/e230951. [PMID: 31471365 DOI: 10.1136/bcr-2019-230951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 70-year-old man with history of metastatic well-differentiated neuroendocrine carcinoma was presented to the hospital with a painful left lower extremity ulcer which started around 3 months prior to presentation. He was treated with antibiotics for cellulitis on multiple occasions with no improvement in his symptoms. On initial laboratory evaluation, he was found to have acute kidney injury and a normal calcium level. The patient underwent a skin biopsy and was found to have cellulitis and calciphylaxis of small-sized and medium-sized vessels. Since the patient did not have any underlying risk factors of calciphylaxis, the most likely cause of his calciphylaxis was thought to be his underlying malignancy. Physicians should keep this differential in mind while treating non-healing ulcers in such patients since they are at higher risk of superimposed infections and usually require aggressive wound care.
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Affiliation(s)
| | - Ahmad Raja
- Internal Medicine, Presence Saint Francis Hospital, Evanston, Illinois, USA
| | - Xia Zhou
- Internal Medicine, Florida Hospital Orlando, Orlando, Florida, USA
| | - Akriti Jain
- Internal Medicine, Florida Hospital Orlando, Orlando, Florida, USA
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Suárez-Peñaranda JM, Minasyan A, Sainz-Gaspar L, Sánchez-Aguilar MD. Resolution of acenocoumarol-associated calciphylaxis with drug withdrawal. Australas J Dermatol 2019; 60:e223-e226. [PMID: 30790279 DOI: 10.1111/ajd.13006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 12/24/2022]
Abstract
Calciphylaxis is a syndrome of cutaneous ischaemic necrosis and ulceration due to arteriolar calcification with subsequent thrombosis, which rarely presents in patients without terminal kidney disease. Recently, several reports of coumarins-associated calciphylaxis have stressed the relevance of anticoagulant therapy as an important risk factor for the development of this condition. We report five cases of acenocoumarol-associated, biopsy-proven calciphylaxis in women aged between 64 and 92 years. The drug had been prescribed for atrial fibrillation and was taken without interruption from 14 to 224 months. Lesions were present for months in all cases and were resistant to multiple therapeutic options, but they resolved only with simple wound care measures 6-14 months after changing the anticoagulant therapy.
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Affiliation(s)
- José-Manuel Suárez-Peñaranda
- Department of Pathology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
| | - Anna Minasyan
- University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Sainz-Gaspar
- Department of Dermatology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
| | - María-Dolores Sánchez-Aguilar
- Department of Dermatology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
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Bajaj R, Courbebaisse M, Kroshinsky D, Thadhani RI, Nigwekar SU. Calciphylaxis in Patients With Normal Renal Function: A Case Series and Systematic Review. Mayo Clin Proc 2018; 93:1202-1212. [PMID: 30060958 DOI: 10.1016/j.mayocp.2018.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To define concomitant risk factors, treatment, and outcomes for patients with nonnephrogenic calciphylaxis (NNC). PATIENTS AND METHODS A retrospective review of Massachusetts General Hospital (MGH) medical records (January 1, 2014, through February 29, 2016) and a systematic literature review of PubMed, Google Scholar, EMBASE, MEDLINE, and CENTRAL (August 1, 1970, through July 31, 2016) were performed. Demographic characteristics and concomitant features were summarized and compared between patients with different lesion characteristics. Outcomes (lesion improvement and mortality) and their predictors were analyzed. RESULTS Nine patients (median age, 72 years [interquartile range (IQR), 44-82 years]; 78% women; 89% white race) were identified through MGH records. The literature review identified 107 patients (median age, 60 years [IQR, 49-72 years]; 77% women; 86% white race). Vitamin K antagonism and obesity were the most common concomitant factors. In the literature review, lower age (P<.001) and higher body mass index (P=.03) were associated with the central location of lesions, whereas vitamin K antagonism was associated with the peripheral location (P=.009). In the MGH series, median survival was 24.0 months (95% CI, 7.8-36.0 months), and 33% (95% CI, 14%-60%) had lesion improvement by 6 months. In the literature review, median survival was 4.2 months (95% CI, 1.9-5.9 months), median time to lesion improvement was 5.9 months (95% CI, 3.9-8.9 months), and none of the treatments were associated with lesion improvement or survival. CONCLUSION This description of concomitant traits may augment an earlier recognition of NNC. Future research is needed to investigate NNC pathogenesis and treatments.
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Affiliation(s)
- Richa Bajaj
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Khorana Scholar 2016, Khorana Program for Scholars, INDO-US Science and Technology Forum, New Delhi, India
| | - Marie Courbebaisse
- Division of Bone and Mineral Research, Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA; Faculty of Medicine, Paris Descartes University, Paris, France
| | | | - Ravi I Thadhani
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Department of Biomedical Sciences and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sagar U Nigwekar
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA.
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Kramer ON, Garden BC, Altman I, Braniecki M, Aronson IK. The Signs Aligned: Nonuremic Calciphylaxis. Am J Med 2017; 130:1051-1054. [PMID: 28601542 DOI: 10.1016/j.amjmed.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Owen N Kramer
- College of Medicine, University of Illinois at Chicago
| | | | - Igor Altman
- Department of Surgery, University of Illinois at Chicago
| | | | - Iris K Aronson
- Department of Dermatology, University of Illinois at Chicago
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Argobi Y, Smith GP. Cutaneous Manifestations of Connective Tissue Disease in the Inpatient Setting. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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