Helmeczi Wryan, Pitre Tyler, Hudson Emma, Mondhe Suhas, Burns Kevin
Department of Internal Medicine, University of Ottawa, ON, Canada.
Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
Can J Kidney Health Dis. 2021 Jul 26;8:20543581211025846. doi: 10.1177/20543581211025846. eCollection 2021.
The recognition of calciphylaxis often eludes practitioners because of its multiple ambiguous presentations. It classically targets areas of the body dense with adipose tissue. A heightened suspicion for the disorder is therefore required in the case of penile calciphylaxis, given its unconventional location. The diagnosis of calciphylaxis is also challenging as the gold standard for diagnosis is biopsy which can often yield equivocal results. Unfortunately, in penile calciphylaxis, the utility of biopsies is further debated due to their potential to precipitate new lesions and their decreased sensitivity due to the limited depth of tissue that can be sampled. For these reasons, it is important that practitioners recognize other accessible and accurate investigative tools which can aid in their diagnosis.
We present the case of a 49-year-old man who presented to the emergency room with penile pain in the context of known chronic kidney disease secondary to diabetic nephropathy. The pain had been present for about a week, was exquisitely tender, and was initially associated with a faint violaceous lesion. This gentleman had just recently initiated peritoneal dialysis and had no other lesions on his body.
His pain was determined by ultrasound and plain radiograph to be secondary to calciphylaxis after two biopsies were nondiagnostic.
The patient had already made changes to his diet to reduce phosphate and calcium intake, and had been on phosphate-lowering therapy with both calcium and phosphate being within their respective target range. Following his diagnosis, this patient was promptly converted from peritoneal dialysis to hemodialysis with sodium thiosulphate and initiated hyperbaric oxygen therapy. This patient continues to be followed by nephrology and urology specialists.
由于钙化防御有多种模糊的表现形式，临床医生常常难以识别。它通常靶向身体脂肪组织密集的区域。鉴于阴茎钙化防御的位置不常见，因此在这种情况下需要提高对该疾病的怀疑。钙化防御的诊断也具有挑战性，因为诊断的金标准是活检，而活检结果往往不明确。不幸的是，在阴茎钙化防御中，活检的效用存在更多争议，因为活检可能会引发新的病变，而且由于可取样的组织深度有限，其敏感性降低。出于这些原因，临床医生认识到其他可获得且准确的调查工具以辅助诊断非常重要。
我们报告一例49岁男性患者，他因糖尿病肾病继发的慢性肾病，出现阴茎疼痛，前往急诊室就诊。疼痛已持续约一周，极为压痛，最初伴有一个淡淡的紫红色病变。这位先生最近刚开始进行腹膜透析，身体其他部位没有病变。
在两次活检未得出诊断结果后，通过超声和X线平片确定他的疼痛是由钙化防御引起的。
患者已经改变饮食以减少磷和钙的摄入，并且一直在进行降磷治疗，磷和钙均在各自的目标范围内。确诊后，该患者迅速从腹膜透析转为血液透析，并使用硫代硫酸钠，同时开始高压氧治疗。该患者继续由肾脏病学和泌尿外科学专家随访。
