Successful Management of Calciphylaxis in a Kidney Transplant Patient: Case Report

Abstract

Calciphylaxis is a rare and often fatal condition mostly associated with end-stage renal disease. The pathophysiology remains elusive and treatment options are scarce. We present a rare case of severe calciphylaxis after kidney transplantation in a patient with persistent hyperparathyroidism.

Case description: A 78-year-old man with a history of end-stage renal disease developed edema and ulcerations on both lower limbs 14 months after kidney transplantation while receiving an mammalian target of rapamycin inhibitor to manage polyoma virus-associated nephropathy. Skin biopsies taken from the ulcerations confirmed calciphylaxis. A multimodal treatment regimen combining medical (calcium-free phosphate binders, cinacalcet, paricalcitol, sodium thiosulfate, antibiotic treatment) and surgical treatments (debridement and autologous skin transplantation) ultimately resulted in successful wound healing.

Discussion: We describe a case of severe calciphylaxis in a nonuremic patient after kidney transplantation. Rapid diagnosis by skin biopsy and an aggressive multimodal therapy regimen followed by long-term oral sodium thiosulfate treatment were crucial factors for a favorable outcome.

FIGURE 1

Skin manifestation of calciphylaxis on the right lower leg. At admission (A), 1 day after surgical debridement (B), 1 day after autologous skin graft transplantation (C), and 7 months after autologous skin graft transplantation (D).

FIGURE 2

Histology of the left lower leg. A, Ischemic necrosis of skin and subcutis. B, C, Intimal proliferation of small vessels with luminal narrowing. Calcification of the media of small vessels in the panniculus with fibroplasia of the intima. A, 25 × H&E, (B) 400 × H&E, (C) 200 × von Kossa staining. H&E, hematoxylin-eosin.