Cerebral, myocardial and cutaneous ischemic necrosis associated with calcific emboli from aortic and mitral valve calcification in a patient with end-stage renal disease.
We report the case of a 57-year-old diabetic male with chronic renal failure who developed secondary hyperparathyroidism and calcification of mitral and aortic valves and interatrial septum. Multiple ischemic lesions developed in the skin of hands, feet and penis, and in the brain, and these were presumed to be due to septic emboli from cardiac valvular infective endocarditis. Multiple blood cultures were negative, however, and despite antibiotic therapy the patient expired. Autopsy (limited to trunk) demonstrated multiple calcific emboli in the heart and spleen, apparently derived from the prominent calcific deformities in the aortic and mitral valves. These were associated with acute and organizing myocardial infarcts and acute splenic infarcts, suggesting that the multiple ischemic lesions in the brain were also due to calcific emboli. A possible contributory component of infective endocarditis, however, was indicated by postmortem cultures of aortic and mitral valves positive for Enterococcus faecium. Calcific embolism is a rarely recognized but potentially lethal complication of end-stage renal disease, and the clinical diagnosis and the preventive therapeutic options for the control of the product of calcium and phosphate and/or parathyroidectomy should be considered.
Li
Y
Y
Department of Pathology and Laboratory Medicine, Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
Muench
A
A
McGregor
D H
DH
Wiegmann
T B
TB
D001021:Aortic Valve / Q000473:pathology*; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D002114:Calcinosis / Q000150:complications* / Q000473:pathology; D004617:Embolism / Q000150:complications* / Q000473:pathology; D006349:Heart Valve Diseases / Q000150:complications* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D017202:Myocardial Ischemia / Q000209:etiology* / Q000473:pathology; D009336:Necrosis; D012871:Skin Diseases / Q000209:etiology* / Q000473:pathology