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Case Reports
. 2022 Jan 18;16(1):18.
doi: 10.1186/s13256-021-03231-4.

Calciphylaxis of the penis and distal digits: a case report

Gordon Smilnak  1 , Michael Jiang  2   3 , Bijal Jain  4   5
Affiliations
Case Reports

Calciphylaxis of the penis and distal digits: a case report

Gordon Smilnak et al. J Med Case Rep. .

Abstract

Background: Calciphylaxis is a rare, often fatal disease resulting from calcification of dermal arterioles and capillaries. Usually diagnosed in patients with end-stage renal disease, this disorder typically presents as necrotic, nonhealing ulcers in acral or adipose areas. Here we report the case of an elderly man who was found to have calciphylaxis of the distal digits and penis, the latter of which is an uncommon site of disease that carries a particularly poor prognosis.

Case presentation: A 73-year-old African American man with multiple medical comorbidities including dialysis-dependent end-stage renal disease presented with worsening painful, necrotic lesions on his glans penis and several distal digits over the last 2 months. The wound on the glans was foul smelling with overlying purulence and had been unsuccessfully treated with amoxicillin-clavulanic acid. Discovery of diffuse intravascular calcification on computed tomography, in addition to a markedly elevated calcium-phosphate product immediately prior to the onset of his ulcers, led to the diagnosis of calciphylaxis. The patient was initiated on sodium thiosulfate without improvement in his lesions, and he died 3 months later after another prolonged hospitalization.

Conclusions: While calciphylaxis is a rare disease, involvement of the distal digits and especially the penis is even more uncommon and portends a particularly poor prognosis: 6-month mortality rates are reportedly as high as 70%. This suggests that prompt recognition and management of the disease is required; however, despite receiving standard therapy, our patient failed to experience improvement in his disease and instead developed several more fingertip ulcers at blood glucose sample points during his hospitalization. A corollary of the case presented here is the need for more effective management of calciphylaxis, especially for patients in whom uncommon sites, such as the penis, are involved.

Keywords: Calciphylaxis; End-stage renal disease; Hemodialysis; Penis; Sodium thiosulfate.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Image of the patient’s penis shortly after admission. Necrosis of the glans with overlying purulence can be seen
Fig. 2
Fig. 2
Computed tomography scan of the patient’s pelvis. Imaging revealed diffuse vascular calcification including the penile arteries, as shown. These radiographic lesions correlated with overlying skin necrosis
See this image and copyright information in PMC

References

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