Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMJ Case Rep. 2021 Nov 2;14(11):e245323. doi: 10.1136/bcr-2021-245323.
An 81-year-old man was admitted under the care of a plastic surgery team with a 10-day history of a painful left lower leg skin lesion after a punch biopsy of a naevus. His background history includes end-stage kidney disease secondary to hypertensive nephropathy, on intermittent haemodialysis via fistula. Other significant background history includes stroke, hypertension and ischaemic heart disease with coronary artery stents. There was no history of warfarin use. He was initially treated with a 5-day course of oral antibiotics with no improvement. He was referred to the hospital where he was admitted under the plastic surgery team who had completed the punch biopsy for intravenous antibiotics for presumed cellulitis. During his admission, the nephrology service were consulted to prescribe routine inpatient haemodialysis. Further history taking and wound review identified a 10-day history of an extremely painful skin lesion with an eschar and surrounding dusky, purpuric skin. Given the disproportionate pain and black eschar which are not in keeping with cellulitis, a diagnosis of calciphylaxis was made. He was commenced sodium thiosulfate on haemodialysis.
一位 81 岁男性，因黑色素痣 punches 活检后 10 天左小腿皮肤病变伴疼痛，收治于整形外科研修团队。其既往病史包括高血压肾病引起的终末期肾病，通过瘘管间歇性血液透析。其他重要病史包括中风、高血压和缺血性心脏病伴冠状动脉支架。无华法林使用史。他最初接受了 5 天的口服抗生素治疗，但没有改善。他被转介到医院，整形外科研修团队在那里完成了 punches 活检，并静脉注射抗生素，疑似为蜂窝织炎。住院期间，肾脏病科会诊，开具常规住院血液透析。进一步的病史询问和伤口检查发现，他有 10 天的极度疼痛的皮肤病变病史，有焦痂和周围暗紫色、紫癜样皮肤。鉴于疼痛不成比例和黑色焦痂与蜂窝织炎不一致，诊断为钙化防御。他开始在血液透析时使用硫代硫酸钠。
