Shinozaki Yasuyuki, Furuichi Kengo, Sagara Akihiro, Kitajima Shinji, Toyama Tadashi, Hara Akinori, Iwata Yasunori, Sakai Norihiko, Shimizu Miho, Kaneko Shuichi, Wada Takashi
Division of Nephrology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Division of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
CEN Case Rep. 2015 Nov;4(2):169-173. doi: 10.1007/s13730-014-0161-y. Epub 2014 Dec 18.
Calciphylaxis is a life-threatening complication of end-stage kidney disease (ESKD) and leads to cutaneous necrosis and gangrene. Various risk factors for calciphylaxis have been reported, and warfarin therapy is a particularly strong trigger. Here we report the case of 50-year-old woman with ESKD and systemic lupus erythematosus who developed calciphylaxis after anti-thrombotic therapy, including warfarin, for ischemic skin ulcers due to arteriosclerosis obliterans and anti-phospholipid antibody syndrome. Although warfarin improved the thrombotic skin ulcers, it might also be a trigger for calciphylaxis. Discontinuation of the warfarin and the addition of low-density lipoprotein apheresis and sodium thiosulfate infusion failed to improve the gangrene; eventually, her legs had to be amputated to prevent lethal infection. The histology of the dermal and soft tissue obtained from the amputated legs showed typical findings of calciphylaxis. Warfarin is a vitamin K antagonist with inhibitory effects on the calcification of regulatory proteins, such as matrix Gla protein and fetuin-A. Therefore, the warfarin therapy might have induced calciphylaxis in our patient.
钙化防御是终末期肾病（ESKD）的一种危及生命的并发症，可导致皮肤坏死和坏疽。已有多种钙化防御的危险因素被报道，而华法林治疗是一个特别强烈的诱因。在此，我们报告一例50岁患有ESKD和系统性红斑狼疮的女性病例，该患者在因闭塞性动脉硬化和抗磷脂抗体综合征导致的缺血性皮肤溃疡接受包括华法林在内的抗血栓治疗后发生了钙化防御。尽管华法林改善了血栓性皮肤溃疡，但它也可能是钙化防御的诱因。停用华法林并加用低密度脂蛋白分离置换法和硫代硫酸钠输注未能改善坏疽；最终，为防止致命感染，不得不对她的双腿进行截肢。从截肢的腿部获取的皮肤和软组织组织学检查显示出钙化防御的典型表现。华法林是一种维生素K拮抗剂，对诸如基质Gla蛋白和胎球蛋白-A等调节蛋白的钙化有抑制作用。因此，华法林治疗可能在我们的患者中诱发了钙化防御。
