Albekery Mohamed A, Alkulaib Munirah K, Alanazi Ahmed A, Alturki Lulwah T, Al Sahlawi Muthana A, Abulikailik Ramy I, Abdelgadir Elbadri I
Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, P.O. Box 400, Hofuf 31982, Saudi Arabia.
Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia.
Healthcare (Basel). 2025 Jan 31;13(3):282. doi: 10.3390/healthcare13030282.
Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare and potentially fatal condition primarily affecting patients with end-stage renal disease (ESRD) on hemodialysis (HD). It is characterized by calcification in small blood vessels, leading to painful skin ulcers and high mortality rates.
This is a case of a 42-year-old female with ESRD on HD who developed calciphylaxis, presenting with non-healing ulcers on her thighs.
Despite initial treatments, including wound care and pain management, her condition did not improve. A skin biopsy was inconclusive, highlighting the diagnostic challenges associated with calciphylaxis. Based on clinical judgment, warfarin and calcium-based therapies were discontinued, and the patient's HD regimen was adjusted. Due to the persistence of symptoms, sodium thiosulfate (STS) therapy was initiated, leading to significant improvement in her ulcers after six months of treatment.
This case highlights the importance of clinical judgment in the diagnosis and management of calciphylaxis, particularly when histopathological diagnostic methods yield inconclusive results. Clinical criteria, alongside a thorough assessment of the patient's history and presentation, are vital for achieving a timely diagnosis in such challenging cases. The successful use of sodium thiosulfate in this patient adds to the growing body of evidence supporting its use as a potential treatment for calciphylaxis, especially in cases that do not respond to conventional therapy.
钙化防御，也称为钙化性尿毒症小动脉病（CUA），是一种罕见且可能致命的疾病，主要影响接受血液透析（HD）的终末期肾病（ESRD）患者。其特征是小血管钙化，导致疼痛性皮肤溃疡和高死亡率。
这是一例42岁接受血液透析的终末期肾病女性患者发生钙化防御的病例，其大腿出现不愈合溃疡。
尽管进行了包括伤口护理和疼痛管理在内的初始治疗，但其病情并未改善。皮肤活检结果不明确，凸显了钙化防御相关的诊断挑战。基于临床判断，停用了华法林和钙基疗法，并调整了患者的血液透析方案。由于症状持续存在，开始使用硫代硫酸钠（STS）治疗，治疗六个月后其溃疡有显著改善。
该病例突出了临床判断在钙化防御诊断和管理中的重要性，尤其是在组织病理学诊断方法结果不明确时。临床标准以及对患者病史和表现的全面评估，对于在此类具有挑战性的病例中及时做出诊断至关重要。该患者成功使用硫代硫酸钠增加了越来越多支持其作为钙化防御潜在治疗方法的证据，特别是在对传统治疗无反应的病例中。
