Department of Endocrinology and Diabetes, The Townsville Hospital, Douglas, Australia.
Endocr Pract. 2011 Jul-Aug;17(4):e104-8. doi: 10.4158/EP11099.CR.
To present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritis and normal renal function.
We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year.
The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritis were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight.
This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy.
报告 1 例肥胖合并静止性类风湿关节炎且肾功能正常患者的罕见钙化防御病例。
我们描述了 1 例 46 岁的病态肥胖白人女性，此前体重为 200kg，在 1 年内体重迅速下降 102kg 后出现疼痛性腿部溃疡。
患者因 6 周的疼痛性腿部溃疡入院，溃疡进展至大腿。临床和生化检查排除血管炎和活动性类风湿关节炎。皮肤活检证实存在钙化防御，同时肾功能正常。血清 25-羟维生素 D 水平较低（14ng/mL，参考范围为 20-200ng/mL），甲状旁腺激素水平升高（241pg/mL，参考范围为 10-65pg/mL），但血清钙和磷水平正常。尽管进行了局部伤口护理、每日高压氧和静脉硫代硫酸钠治疗，但皮肤病变仍持续存在。通过口服补充使血清维生素 D 水平正常化后，她对帕米膦酸二钠输注反应良好，溃疡完全愈合，并恢复了发病前体重的 13%。
这是首例在维生素 D 缺乏且体重减轻超过 100kg 的患者中发生的钙化防御病例，对帕米膦酸二钠治疗有反应。
