Non Uremic Calciphylaxis Post Liver Transplantation: A Case Report and Literature Review of an Unusual Presentation of a Rare Disease

Abstract

BACKGROUND Calciphylaxis results from abnormal calcification of small to medium sized vessels, resulting in painful ischemic necrosis of the surrounding tissues. It is most commonly seen in patients with end stage renal disease on dialysis, but has also been reported in patients with preserved renal function. CASE REPORT We report a case of non uremic calciphylaxis in a 65-year-old female who presented with painful skin lesions and ulcerations involving both thighs one month after receiving a liver transplantation. She was treated with sodium thiosulfate along with wound care and hyperbaric oxygen with complete resolution of the lesions, but with residual scarring. CONCLUSIONS Non uremic calciphylaxis is a rare phenomenon that is poorly understood. It should be in the differential of unexplained skin lesions even in the absence of renal insufficiency. Sodium thiosulfate plays a role in treatment, but wound care remains the main focus of treatment.

Figure 1.

Subcutaneous nodules with ulceration and eschar formation of overlying skin involving the medial side of the thighs bilaterally. Black arrows: necrotic lesions.

Figure 2.

Healed lesions with residual scarring after five months of treatment with sodium thiosulfate, wound care, and hyperbaric oxygen. White arrows: healed lesions with scarring of both right and left thighs.