van Rijssen L B, Brenninkmeijer E E A, Nieveen van Dijkum E J M
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Surg Case Rep. 2012;3(1):30-3. doi: 10.1016/j.ijscr.2011.08.015. Epub 2011 Oct 28.
Most leg ulcers are vascular based. Only if vascular therapy fails other causes are considered. We report the case of a female with incapacitating leg ulcers caused by a rare condition which was only diagnosed after failing treatment.
The female had an extensive previous history including diabetes, renal insufficiency and cardiovascular disease and presented with three large and painful ulcers on her left lower leg. Standard treatment with antibiotics, wound excision and additional treatment with hyperbaric oxygen were ineffective. One month post hospital-admission calciphylaxis cutis caused by renal failure induced secondary hyperparathyroidism was diagnosed. Surgical treatment by a parathyroidectomy induced rapid regeneration of the ulcers.
Our patient's vast comorbidity and previous history had expanded differential considerations causing a delay in diagnosis. Our patient's previous history led us to believe her ulcers were vascular based, however her chronic renal failure appeared responsible for her condition.
Although less probable than venous insufficiency and concomittant leg ulcers or other differential considerations, calciphylaxis cutis should be part of the differential diagnosis in any end stage renal disease-patient with unexplained ulcers as an effective therapy is readily available.
大多数腿部溃疡是基于血管问题。只有在血管治疗失败后才会考虑其他病因。我们报告一例女性患者，其腿部溃疡导致功能丧失，病因罕见，在治疗失败后才得以诊断。
该女性有广泛的既往病史，包括糖尿病、肾功能不全和心血管疾病，左小腿出现三个大的疼痛性溃疡。使用抗生素、伤口切除及高压氧辅助治疗均无效。入院一个月后，诊断为肾衰竭继发甲状旁腺功能亢进引起的钙化防御性皮肤病变。甲状旁腺切除手术治疗后溃疡迅速愈合。
患者大量的合并症和既往病史增加了鉴别诊断的难度，导致诊断延迟。患者的既往病史使我们认为其溃疡是基于血管问题，然而其慢性肾衰竭似乎是病因。
尽管钙化防御性皮肤病变比静脉功能不全及合并腿部溃疡或其他鉴别诊断情况的可能性小，但对于任何患有无法解释的溃疡的终末期肾病患者，钙化防御性皮肤病变都应作为鉴别诊断的一部分，因为有现成的有效治疗方法。
