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Calciphylaxis in chronic, non-dialysis-dependent renal disease.

Pliquett RU, Schwock J, Paschke R, Achenbach H - BMC Nephrol (2003)

Bottom Line: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers.The role of renal disease in vascular complications is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, University of Leipzig, Phillip-Rosenthal-Str, 27, Leipzig, Germany. rpliquett@endothel.de

ABSTRACT

Background: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.

Case report: A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV) having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction.

Conclusions: The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.

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Calciphylaxis cutis, 4 months after admission. Size enlargement of calciphylactic ulcerations. Maggot debridement therapy abolished superinfection to a large extent.
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Figure 3: Calciphylaxis cutis, 4 months after admission. Size enlargement of calciphylactic ulcerations. Maggot debridement therapy abolished superinfection to a large extent.

Mentions: About 4 months after first admission, the patient was readmitted with signs of sepsis necessitating an escalated antibiotic treatment and surgical wound care. Yet conventional necrectomy proved ineffective. Therefore, maggot debridement therapy using sterile maggots of the greenbottle fly Lucilia sericata was introduced. Following four courses, the wounds gradually improved, granulated and showed signs of healing, yet the large extent of those wounds remained, rendering the patient at high risk of reinfection (Figure 3). As an adjunct antibiotic therapy, a combination of piperacillin-combactam was given over 9 days. The subcutaneous nodule-like tumors continued to occur at new locations. The patient's overall condition remained poor. Six days after being transferred to a primary hospital, she was readmitted because of acute renal failure. In addition, she suffered from the consequences of a stroke, with right-side hemiparesis, as well as from worsened crural ulcerations and a new pre-sacral pressure-sore lesion. A urinary-tract infection with Pseudomonas aeruginosa was diagnosed. The patient died within 4 days of a systemic-inflammatory response syndrome primarily due to her superinfected, poorly controllable wounds.


Calciphylaxis in chronic, non-dialysis-dependent renal disease.

Pliquett RU, Schwock J, Paschke R, Achenbach H - BMC Nephrol (2003)

Calciphylaxis cutis, 4 months after admission. Size enlargement of calciphylactic ulcerations. Maggot debridement therapy abolished superinfection to a large extent.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC222929&req=5

Figure 3: Calciphylaxis cutis, 4 months after admission. Size enlargement of calciphylactic ulcerations. Maggot debridement therapy abolished superinfection to a large extent.
Mentions: About 4 months after first admission, the patient was readmitted with signs of sepsis necessitating an escalated antibiotic treatment and surgical wound care. Yet conventional necrectomy proved ineffective. Therefore, maggot debridement therapy using sterile maggots of the greenbottle fly Lucilia sericata was introduced. Following four courses, the wounds gradually improved, granulated and showed signs of healing, yet the large extent of those wounds remained, rendering the patient at high risk of reinfection (Figure 3). As an adjunct antibiotic therapy, a combination of piperacillin-combactam was given over 9 days. The subcutaneous nodule-like tumors continued to occur at new locations. The patient's overall condition remained poor. Six days after being transferred to a primary hospital, she was readmitted because of acute renal failure. In addition, she suffered from the consequences of a stroke, with right-side hemiparesis, as well as from worsened crural ulcerations and a new pre-sacral pressure-sore lesion. A urinary-tract infection with Pseudomonas aeruginosa was diagnosed. The patient died within 4 days of a systemic-inflammatory response syndrome primarily due to her superinfected, poorly controllable wounds.

Bottom Line: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers.The role of renal disease in vascular complications is discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology, University of Leipzig, Phillip-Rosenthal-Str, 27, Leipzig, Germany. rpliquett@endothel.de

ABSTRACT

Background: Calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients.

Case report: A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV) having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction.

Conclusions: The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.

Show MeSH
Related in: MedlinePlus