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

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

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References

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a Department of Cardiology, University of Tennessee-Memphis, Memphis, Tennessee, USA

b Department of Internal Medicine, KU School of Medicine-Wichita, The University of Kansas, North Kansas Wichita, Kansas, USA

c Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA

d Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA

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

Correspondence to: Dr. Mazen Hussein Shaheen, University of Cincinnati, 234 Goodman Street ML#0501, Cincinnati, Ohio 45267-0501, USA

PII: S1561-5413(09)60245-3

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

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