Grant Medical Center Foot & Ankle Surgery Resident, Columbus, OH.
Kent State University College of Podiatric Medicine, Independence, OH.
J Foot Ankle Surg. 2022 Sep-Oct;61(5):e41-e47. doi: 10.1053/j.jfas.2021.10.024. Epub 2021 Oct 27.
Nonuremic calciphylaxis is a rare condition presenting with peripheral ischemic ulcerations. Calciphylaxis is the deposition of calcium and phosphate into arteriolar walls caused by exceeding their solubility range in the blood. It is most commonly seen in patients with end-stage renal disease; however, nonuremic calciphylaxis occurs in patients with normal or mildly impaired renal function. Risk factors for nonuremic calciphylaxis include Coumadin therapy, obesity, and diabetes mellitus. Histopathologic examination of deep skin biopsy containing subcutaneous adipose tissue reveals medial calcification of dermal and subcutaneous arterioles. This diagnosis must be managed locally with wound care and systemically by control of blood calcium solubility. Avoidance of infection is critical to survival. Here we report a case of calciphylaxis in a patient with normal renal function and serum levels of calcium and phosphorus who presented with gangrene of the extremities. Increased awareness of this debilitating disease will lead to earlier diagnosis, proper treatment and improved patient outcomes.
非尿毒症性钙化防御是一种罕见的疾病，表现为周围缺血性溃疡。钙化防御是指钙和磷酸盐在血管壁中的沉积，这是由于它们在血液中的溶解度超过了其范围。它最常见于终末期肾病患者；然而，非尿毒症性钙化防御也发生在肾功能正常或轻度受损的患者中。非尿毒症性钙化防御的危险因素包括华法林治疗、肥胖和糖尿病。包含皮下脂肪组织的深部皮肤活检的组织病理学检查显示真皮和皮下小动脉的中层钙化。这个诊断必须通过局部的伤口护理和通过控制血钙的溶解度进行全身治疗来管理。避免感染对生存至关重要。在这里，我们报告了一例肾功能正常、血钙和血磷水平正常的患者发生四肢坏疽的钙化防御病例。提高对这种使人衰弱的疾病的认识将有助于早期诊断、适当治疗和改善患者的预后。
