Ali Faria, Matharu Tarvinder, Nagesh R Venkata, Gordon Spratt Elizabeth, Friedman Ben J
Henry Ford Health System, Jackson, MI.
Wounds. 2020 Sep;32(9):E42-E49.
Calciphylaxis is a serious condition that often occurs in patients with end-stage renal failure undergoing hemodialysis, with potential comorbidities of hyperparathyroidism and chronic kidney disease (CKD). It is a result of progressive calcification in small- and medium-sized arteries. Causing ischemia in multiple organs and skin ulcers, calciphylaxis has a poor prognosis. No definitive therapeutic or diagnostic guideline exists to prevent the devastating consequences of calciphylaxis. Association of warfarin with calciphylaxis has been reported in the literature, but, to the authors' knowledge, there are no literature reports of patients with CKD who were not on dialysis or warfarin developing calciphylaxis.
The authors report an unusual case of calciphylaxis in a patient with stage 3 CKD who was not on dialysis, warfarin, or insulin.
A 72-year-old female with a history of type 2 diabetes mellitus, who was not taking subcutaneous insulin and had stage 3 CKD, was diagnosed with calciphylaxis by skin biopsy. She was treated with intravenous sodium thiosulfate twice weekly for 2 months with complete resolution of skin lesions.
This case illustrates that early diagnosis, intervention, and a multidisciplinary approach are of utmost importance in the management of calciphylaxis. Sodium thiosulfate, when used in the correct setting, can improve prognosis in patients. Serious consideration should be given to sodium thiosulfate as a practical measure of treatment.
钙化防御是一种严重病症，常发生于接受血液透析的终末期肾衰竭患者，可能合并甲状旁腺功能亢进和慢性肾脏病（CKD）。它是中小动脉进行性钙化的结果。钙化防御会导致多器官缺血和皮肤溃疡，预后较差。目前尚无明确的治疗或诊断指南来预防钙化防御带来的灾难性后果。文献中已报道华法林与钙化防御有关，但据作者所知，尚无关于未接受透析或未使用华法林的CKD患者发生钙化防御的文献报道。
作者报告一例未接受透析、未使用华法林及胰岛素的3期CKD患者发生钙化防御的罕见病例。
一名72岁女性，有2型糖尿病病史，未使用皮下胰岛素，患有3期CKD，经皮肤活检诊断为钙化防御。她接受了每周两次的静脉注射硫代硫酸钠治疗，持续2个月，皮肤病变完全消退。
该病例表明，早期诊断、干预及多学科方法在钙化防御的管理中至关重要。硫代硫酸钠在正确的情况下使用可改善患者预后。应认真考虑将硫代硫酸钠作为一种切实可行的治疗措施。
