Hong Kong Journal of Nephrology
Volume 11, Issue 2 , Pages 66-69, October 2009

Non-healing Skin Ulcers Secondary to Calciphylaxis with Candida tropicalis Fungemia in an End-stage Renal Disease Patient

  • Mazen Shaheen

      Affiliations

    • Department of Cardiology, University of Tennessee-Memphis, Memphis, Tennessee, USA
    • Corresponding Author InformationCorrespondence to: Dr. Mazen Hussein Shaheen, University of Cincinnati, 234 Goodman Street ML#0501, Cincinnati, Ohio 45267-0501, USA
    • ,
  • Dalia Hammoud

      Affiliations

    • Department of Internal Medicine, KU School of Medicine-Wichita, The University of Kansas, North Kansas Wichita, Kansas, USA
    • ,
  • Dimpi Patel

      Affiliations

    • Department of Cardiology, University of Tennessee-Memphis, Memphis, Tennessee, USA
    • ,
  • Lisa Le

      Affiliations

    • Department of Internal Medicine, KU School of Medicine-Wichita, The University of Kansas, North Kansas Wichita, Kansas, USA
    • ,
  • Mohammad Abdallah

      Affiliations

    • Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
    • ,
  • Wassef Karrowni

      Affiliations

    • Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
    • ,
  • Chimezie Amanambu

      Affiliations

    • Department of Internal Medicine, University of Akron, Akron, Ohio, USA

Article Outline

Calciphylaxis is an uncommon necrotizing skin condition characterized by excessive calcification of soft tissue and small arteries, leading to ischemic ulceration of the skin. It mainly affects patients with chronic renal failure and often leads to fatal consequences. Chronic renal failure, hyperparathyroidism, hypercalcemia, and hyper-phosphatemia often trigger the precipitation of calcium-phosphate crystals in the arterioles of the dermis and soft tissues, leading to ischemia and skin ulcerations. The diagnosis of calciphylaxis is mainly clinical and skin biopsy is infrequently done because of the risk of poor healing and secondary infections. Despite aggressive treatment regimens, mortality is high. Here, we report the case of a 44-year-old female end-stage renal disease patient with multiple non-healing skin ulcers secondary to calciphylaxis complicated with refractory infections including Candida tropicalis fungemia, vancomycin-resistant enterococcus and Acinetobacter baumannii wound infections.

Key words:  calciphylaxis , Candida tropicalis , end-stage renal disease , fungemia , skin ulcers

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Hafner J , Keusch G , Wahl C , Burg G . Calciphylaxis: a syndrome of skin necrosis and acral gangrene in chronic renal failure . Vasa . 1998;27:137–143
  2. Fine A , Zacharias J . Calciphylaxis is usually non-ulcerating: risk factors, outcome and therapy . Kidney Int . 2002;61:2210–2217
  3. Angelis M , Wong LL , Myers SA , Wong LM . Calciphylaxis in patients on hemodialysis: a prevalence study . Surgery . 1997;122:1083–1090
  4. Kurban MS , Boueiz A , Kibbi AG . Cutaneous manifestations of chronic kidney disease . Clin Dermatol . 2008;26:255–264
  5. Selye H . Calciphylaxis . Chicago: University of Chicago Press; 1962;
  6. Gipstein RM , Coburn JW , Adams DA , Lee DB , Parsa KP , Sellers A , et al.   Calciphylaxis in man. A syndrome of tissue necrosis and vascular calcification in 11 patients with chronic renal failure . Arch Intern Med . 1976;136:1273–1280
  7. Fine A , Fleming S , Leslie W . Calciphylaxis presenting with calf pain and plaques in four continuous ambulatory peritoneal dialysis patients and in one predialysis patient . Am J Kidney Dis . 1995;25:498–502
  8. Kent RB , Lylerly RT . Systemic calciphylaxis . South Med J . 1994;87:278–281
  9. Milas M , Bush RL , Lin P , Brown K , Mackay G , Lumsden A , et al.   Calciphylaxis and nonhealing wounds: the role of the vascular surgeon in a multidisciplinary treatment . J Vasc Surg . 2003;37:501–507
  10. Basile C , Montanaro A , Masi M , Pati G , De Maio P , Gismondi A . Hyperbaric oxygen therapy for calcific uremic arteriolopathy: a case series . J Nephrol . 2002;15:676–680
  11. Budisavljevic MN , Cheek D , Ploth DW . Calciphylaxis in chronic renal failure . J Am Soc Nephrol . 1996;7:978–982
  12. Kosmin D , DeHoratius R . Calciphylaxis: an important imitator of cutaneous vasculitis . Arthritis Rheum . 2007;57:533–537
  13. Lugo-Somolinos A , Sanchez JL , Mendez-Coll J , Joglar F . Calcifying panniculitis associated with polycystic kidney disease and chronic renal failure . J Am Acad Dermatol . 1990;22:743–747
  14. Wenzel-Seifert K , Harwig S , Keller F . Fulminant calcinosis in two patients after kidney transplantation . Am J Nephrol . 1991;11:497–500
  15. Kolton B , Pedersen J . Calcinosis cutis and renal failure . Arch Dermatol . 1974;110:256–257
  16. Oh DH , Eulau D , Tokugawa DA , McGuire JS , Kohler S . Five cases of calciphylaxis and a review of the literature . J Am Acad Dermatol . 1999;40:979–987
  17. Kang AS , McCarthy JT , Rowland C , Farley DR , van Heerden JA . Is calciphylaxis best treated surgically or medically? . Surgery . 2000;128:967–972
  18. Llach F . The evolving pattern of calciphylaxis: therapeutic considerations . Nephrol Dial Transplant . 2001;16:448–451
  19. Don BR , Chin AI . A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies . Clin Nephrol . 2003;59:463–470
  20. Cicone JS , Petronis JB , Embert CD , Spector DA . Successful treatment of calciphylaxis with intravenous sodium thiosulfate . Am J Kidney Dis . 2004;43:1104–1108

PII: S1561-5413(09)60245-3

doi:10.1016/S1561-5413(09)60245-3

Hong Kong Journal of Nephrology
Volume 11, Issue 2 , Pages 66-69, October 2009

Article Tools