Gonzalez DE, Foresto RD, Maldonado ALS, Padilha WSC, Roberto FB, Pereira MEVDC, Durão Junior MDS, Carvalho AB. Multiple extremity necrosis in fatal calciphylaxis: Case report.
ACTA ACUST UNITED AC 2021;
43:274-278. [PMID:
32645129 PMCID:
PMC8257280 DOI:
10.1590/2175-8239-jbn-2020-0025]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022]
Abstract
Introduction:
The clinical impact of vascular calcification is well established in the
context of cardiovascular morbidity and mortality, but other clinical
syndromes, such as calciphylaxis, although less frequent, have a significant
impact on chronic kidney disease.
Methods:
Case report of a 27-year-old woman, who had complained of bilateral pain in
her toes for 3 days, with the presence of small necrotic areas in the
referred sites. She had a history of type 1 diabetes (25 years ago), with
chronic kidney disease, on peritoneal dialysis, in addition to rheumatoid
arthritis. She was admitted to the hospital, which preceded the current
condition, due to exacerbation of rheumatoid arthritis, evolving with
intracardiac thrombus due to venous catheter complications, when she started
using warfarin. Ischemia progressed to her feet, causing the need for
bilateral amputations. Her chirodactyls were also affected. Thrombophilia,
vasculitis, endocarditis or other embolic sources were investigated and
discarded. Her pathology report evidenced skin necrosis and superficial soft
parts with recent arterial thrombosis, and Monckeberg's medial
calcification. We started treatment with bisphosphonate and sodium
thiosulfate, conversion to hemodialysis and replacement of warfarin with
unfractionated heparin. Despite all the therapy, the patient died after four
months of evolution.
Discussion:
Calciphylaxis is a rare microvasculature calcification syndrome that results
in severe ischemic injuries. It has pathogenesis related to the mineral and
bone disorder of chronic kidney disease combined with the imbalance between
promoters and inhibitors of vascular calcification, with particular
importance to vitamin K antagonism.
Conclusion:
The preventive strategy is fundamental, since the therapy is complex with
poorly validated effectiveness.
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