Delma Samuel, Isnard-Bagnis Corinne, Deray Gilbert, Barthelemy Raphaël Nail, Mercadal Lucile, Desbuissons Geoffroy
Service de néphrologie, groupe hospitalier La Pitié-Salpêtrière, 75013 Paris, France.
Service de chirurgie plastique, hôpital Tenon, 75015 Paris, France.
Nephrol Ther. 2018 Dec;14(7):548-553. doi: 10.1016/j.nephro.2018.08.001. Epub 2018 Oct 29.
Calciphylaxis or calcific uremic arteriolopathy (CUA) is a cutaneous disease with ulcerations secondary to calcification of cutaneous and subcutaneous small arteries and arterioles. It is a rare but severe disease with significant morbidity and mortality affecting 1 to 4% of dialysis patients. The circumstances of occurrence are multiple.
We report the case of a severe bilateral lower limb calciphylaxis in a 69-year-old, obese, hemodialysis patient with a recent diagnosis of Graves' disease complicated with hypercalcemia and cardiac arrhythmia requiring the use of vitamin K antagonist. Complex and multidisciplinary therapeutic management (daily hemodialysis, sodium thiosulfate therapy, treatment of hypercalcemia by denosumab, hyperbaric oxygen therapy, meshed skin autograft) allowed complete healing of the lesions.
This is the first description of AUC secondary to hyperthyroidism in a dialysis patient. Multidisciplinary care is essential to achieve clinical improvement in those critical situations.
钙化防御或钙化性尿毒症小动脉病(CUA)是一种皮肤疾病,继发于皮肤和皮下小动脉及小动脉钙化,可出现溃疡。它是一种罕见但严重的疾病,发病率和死亡率都很高,影响1%至4%的透析患者。发病情况多种多样。
我们报告了一例69岁肥胖血液透析患者双侧下肢严重钙化防御的病例,该患者最近被诊断为格雷夫斯病,并发高钙血症和心律失常,需要使用维生素K拮抗剂。复杂的多学科治疗管理(每日血液透析、硫代硫酸钠治疗、地诺单抗治疗高钙血症、高压氧治疗、网状自体皮肤移植)使病变完全愈合。
这是首次描述透析患者继发于甲状腺功能亢进的AUC。在这些危急情况下,多学科护理对于实现临床改善至关重要。