Borges Lisa, Rosa Pedro, Dias Emanuel, Cássio Isabel
Department of Vascular Surgery, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
Hyperbaric Medicine Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
BMJ Case Rep. 2014 Jul 17;2014:bcr2014204354. doi: 10.1136/bcr-2014-204354.
A 48-year-old woman performing peritoneal dialysis for end-stage renal disease presented with a painful leg ulcer. The investigation revealed an elevated parathyroid hormone level and the histological examination of the biopsy tissue from the ulcer revealed medial calcification of the arterioles, consistent with calciphylaxis. The patient developed additional ulcers in the lower limbs and treatment with antibiotics, cinacalcet, sevelamer, sodium thiosulfate, low calcium dialysate and hyperbaric oxygen therapy was instituted. The patient had a favourable outcome and after 9 months the ulcers had healed and the parathyroid hormone level reached the normal range. Calciphylaxis is a rare and life-threatening disorder associated with a mortality of 60-80%. Its pathogenesis is not fully understood hence there is no consensus in the treatment of this pathology.
一名48岁因终末期肾病接受腹膜透析的女性出现腿部疼痛性溃疡。检查发现甲状旁腺激素水平升高，对溃疡活检组织的组织学检查显示小动脉中层钙化，符合钙化防御表现。该患者下肢又出现了溃疡，并开始使用抗生素、西那卡塞、司维拉姆、硫代硫酸钠、低钙透析液和高压氧治疗。患者预后良好，9个月后溃疡愈合，甲状旁腺激素水平恢复正常范围。钙化防御是一种罕见且危及生命的疾病，死亡率为60%-80%。其发病机制尚未完全明确，因此在这种病症的治疗上尚无共识。
