title: Intestinal ischemia and peripheral gangrene in a patient with chronic renal failure.
abstract: Gastrointestinal complications are common in patients with renal failure and result in significant morbidity and mortality. Systemic calciphylaxis is an uncommon complication of renal failure, characterized by disseminated intravascular calcification and associated with progressive vascular compromise. We describe the case of a 63-year-old woman who presented with abdominal pain, elevated transaminases, and skin manifestations consistent with a vasculitic process. Hand films and skin biopsies showed extensive vascular calcification, and a computerized tomography scan confirmed colonic perforation and disseminated visceral vascular calcification. Histologic analysis of the resected skin and colonic tissues revealed extensive ischemic damage and mural calcification of medium to large vessels. Gastrointestinal involvement has been reported in only 3 prior cases of calciphylaxis; consequently, gastroenterologists are often unaware of this disease entity and may fail to recognize it, even in patients with the classical presentation. Prompt diagnosis is crucial, as parathyroidectomy may result in clinical improvement in up to two thirds of patients who present with elevated parathyroid hormone levels.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia, Charlottesville, Virginia, USA. JR3U@virginia.edu
authors.forename: Jesús
authors.initials: J
authors.lastname: Rivera-Nieves
authors.forename: Giorgos
authors.initials: G
authors.lastname: Bamias
authors.forename: Jonathan
authors.initials: J
authors.lastname: Alfert
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bickston
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Moskaluk
authors.forename: Fabio
authors.initials: F
authors.lastname: Cominelli
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D002115:Calciphylaxis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D005260:Female; D005385:Fingers / Q000473:pathology; D005734:Gangrene / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007422:Intestines / Q000473:pathology*; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology*; D008875:Middle Aged; D011877:Radionuclide Imaging; D014057:Tomography, X-Ray Computed