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Calciphylaxis in a Patient With Alcoholic Cirrhosis.

Akhtar E, Parikh DA, Torok NJ - ACG Case Rep J (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Harbor UCLA Medical Center, Torrance, CA.

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A 38-year-old woman with alcoholic cirrhosis was admitted with a recurrent lower extremity rash... One year later, the patient presented with recurrence of the painful violaceous rash (Figure 1)... Her calcium, phosphorus, parathyroid hormone, creatinine, and protein C and S levels were normal... An abdominal CT was significant for findings consistent with cirrhosis... The patient was started on sodium thiosulfate therapy and local wound care, and responded well without recurrence to date... Calciphylaxis is a rare, life-threatening syndrome characterized by cutaneous ischemic necrosis secondary to vascular calcification... It is seen almost exclusively in end-stage renal disease, but has been associated with cirrhosis in 9 case reports... The pathogenesis of calciphylaxis is unclear, but commonly described risk factors include female sex, obesity, protein C and S deficiency, corticosteroid use, albumin or blood transfusions, and high calcium-phosphorus product... Sodium thiosulfate, an emerging therapy for calciphylaxis, acts by binding calcium and decreasing reactive oxygen species... Author contributions: All authors participated equally in the creation of this manuscript... Akhtar is the article guarantor... Financial disclosure: None to report... Informed consent was obtained for this case report.

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Painful violaceous rash on lower extremities due to calciphylaxis.
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Figure 1: Painful violaceous rash on lower extremities due to calciphylaxis.

Mentions: A 38-year-old woman with alcoholic cirrhosis was admitted with a recurrent lower extremity rash. She had presented 1 year prior with a history of alcohol abuse, abdominal pain, fatigue, and a violaceous rash over the abdomen and proximal lower extremities. A skin biopsy showed multiple small vessels with calcification of the outer wall suggesting calciphylaxis. The patient was treated with sodium thiosulfate 25 mg intravenously 3 times weekly and serial wound debridement. She had symptom improvement within 3 weeks and resolution of the rash. One year later, the patient presented with recurrence of the painful violaceous rash (Figure 1). She denied any alcohol use over the last year. She had not been receiving albumin infusions or blood transfusions, and her body mass index (BMI) was 22 kg/m2. Evidence of a healed skin graft was noted on her left thigh, with surrounding tender punctate erythema. Her calcium, phosphorus, parathyroid hormone, creatinine, and protein C and S levels were normal. An abdominal CT was significant for findings consistent with cirrhosis. The patient was started on sodium thiosulfate therapy and local wound care, and responded well without recurrence to date.


Calciphylaxis in a Patient With Alcoholic Cirrhosis.

Akhtar E, Parikh DA, Torok NJ - ACG Case Rep J (2015)

Painful violaceous rash on lower extremities due to calciphylaxis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508942&req=5

Figure 1: Painful violaceous rash on lower extremities due to calciphylaxis.
Mentions: A 38-year-old woman with alcoholic cirrhosis was admitted with a recurrent lower extremity rash. She had presented 1 year prior with a history of alcohol abuse, abdominal pain, fatigue, and a violaceous rash over the abdomen and proximal lower extremities. A skin biopsy showed multiple small vessels with calcification of the outer wall suggesting calciphylaxis. The patient was treated with sodium thiosulfate 25 mg intravenously 3 times weekly and serial wound debridement. She had symptom improvement within 3 weeks and resolution of the rash. One year later, the patient presented with recurrence of the painful violaceous rash (Figure 1). She denied any alcohol use over the last year. She had not been receiving albumin infusions or blood transfusions, and her body mass index (BMI) was 22 kg/m2. Evidence of a healed skin graft was noted on her left thigh, with surrounding tender punctate erythema. Her calcium, phosphorus, parathyroid hormone, creatinine, and protein C and S levels were normal. An abdominal CT was significant for findings consistent with cirrhosis. The patient was started on sodium thiosulfate therapy and local wound care, and responded well without recurrence to date.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Harbor UCLA Medical Center, Torrance, CA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 38-year-old woman with alcoholic cirrhosis was admitted with a recurrent lower extremity rash... One year later, the patient presented with recurrence of the painful violaceous rash (Figure 1)... Her calcium, phosphorus, parathyroid hormone, creatinine, and protein C and S levels were normal... An abdominal CT was significant for findings consistent with cirrhosis... The patient was started on sodium thiosulfate therapy and local wound care, and responded well without recurrence to date... Calciphylaxis is a rare, life-threatening syndrome characterized by cutaneous ischemic necrosis secondary to vascular calcification... It is seen almost exclusively in end-stage renal disease, but has been associated with cirrhosis in 9 case reports... The pathogenesis of calciphylaxis is unclear, but commonly described risk factors include female sex, obesity, protein C and S deficiency, corticosteroid use, albumin or blood transfusions, and high calcium-phosphorus product... Sodium thiosulfate, an emerging therapy for calciphylaxis, acts by binding calcium and decreasing reactive oxygen species... Author contributions: All authors participated equally in the creation of this manuscript... Akhtar is the article guarantor... Financial disclosure: None to report... Informed consent was obtained for this case report.

No MeSH data available.


Related in: MedlinePlus