title: Successful treatment of a patient with severe calcific uremic arteriolopathy (calciphylaxis) by etidronate disodium.
abstract: A 59-year-old woman with a 10-year history of hemodialysis was admitted to our hospital for painful skin ulcers on her right thigh, right calf, and left upper arm. A whole-body plain computed tomographic scan showed diffuse calcification of the uterus and marked calcification of the mitral valve. Skin biopsy specimens from the left thigh showed calcium deposition in numerous small blood vessels in the dermis and fat, leading to a diagnosis of calcific uremic arteriolopathy (CUA). Despite antibiotic therapy and aggressive wound care for 2 months, the skin ulcers enlarged and the patient's general condition worsened. Surprisingly, oral administration of etidronate disodium (200 mg/d) strikingly improved the focal infection and decreased the size of the skin ulcers within several days. She was discharged from the hospital 2 months later, when epithelialization of the ulcers was almost complete. We report a case of CUA that was improved dramatically by treatment with etidronate. Etidronate therapy should be considered for refractory CUA.
authors.affiliation: Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. naokis@kumamoto-u.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Shiraishi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kitamura
authors.forename: Taku
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Masataka
authors.initials: M
authors.lastname: Adachi
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Kohda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Shuuko
authors.initials: S
authors.lastname: Misumi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Murayama
authors.forename: Masao
authors.initials: M
authors.lastname: Tomita
authors.forename: Kimio
authors.initials: K
authors.lastname: Tomita
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002115:Calciphylaxis / Q000188:drug therapy* / Q000209:etiology; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D006435:Renal Dialysis; D012883:Skin Ulcer / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D012968:Etidronic Acid