Sanguankeo Anawin, Thamcharoen Natanong, Upala Sikarin
Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA, and.
Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Clin Nephrol Case Stud. 2017 Jul 6;5:38-41. doi: 10.5414/CNCS108959. eCollection 2017.
Calciphylaxis in a nondialysis patient is a rare condition and is characterized by calcific deposition in tissue. We present a case of calciphylaxis in a nondialysis patient who was diagnosed by clinical presentation and skin biopsy and was treated with sodium thiosulfate with improvement of skin lesions.
A 43-year-old female with type 2 diabetes and atrial fibrillation taking oral anticoagulation medication presented with reddish drainage from the right buttock. On physical examination, a large perirectal abscess overlying necrosis was found. She also developed acute kidney injury with creatinine of 3.7 mg/dL at peak from 0.8 mg/dL at baseline. She received antibiotics intravenously and wound debridement. During hospitalization, she developed areas of numerous painful erythematous lesions with central dusky necrosis on bilateral lower extremities. Punch biopsy was done, which initially revealed small-vessel vasculitis. However, those lesions did not respond to steroid therapy. A second biopsy was done showing extensive fat necrosis and medial calcification of vessel walls consistent with calciphylaxis. She was treated with high-flow oxygen and sodium thiosulfate intralesionally and intravenously for 6 months. The lesions remarkably reduced in size and were less painful on follow-up.
High-dose oxygen and sodium thiosulfate could potentially be effective treatments for calciphylaxis in nondialysis patients.
非透析患者的钙化防御是一种罕见病症，其特征为组织中出现钙化沉积。我们报告一例非透析患者的钙化防御病例，该患者通过临床表现和皮肤活检得以确诊，并接受了硫代硫酸钠治疗，皮肤病变有所改善。
一名43岁患有2型糖尿病且正在服用口服抗凝药物的女性因右臀部出现带血色渗液前来就诊。体格检查发现直肠周围有一个巨大的脓肿，表面有坏死。她还出现了急性肾损伤，肌酐水平从基线时的0.8mg/dL升至峰值3.7mg/dL。她接受了静脉抗生素治疗和伤口清创术。住院期间，她双侧下肢出现了多处疼痛性红斑病变，中央呈暗黑色坏死。进行了打孔活检，最初显示为小血管血管炎。然而，这些病变对类固醇治疗无反应。再次活检显示广泛的脂肪坏死和血管壁中层钙化，符合钙化防御表现。她接受了高流量氧气和硫代硫酸钠的局部及静脉注射治疗，为期6个月。随访时病变大小显著减小，疼痛减轻。
高剂量氧气和硫代硫酸钠可能是治疗非透析患者钙化防御的有效方法。
