Penile calciphylaxis: a life-threatening condition successfully treated with sodium thiosulfate.
Calciphylaxis or calcific uremic arteriolopathy is a life-threatening condition that predominantly affects patients with end-stage renal disease on hemodialysis. A prevalence of up to 4% and a 6-month mortality rate of up to 80% have been reported in those with proximal disease (thighs, abdomen wall, and buttocks). Penile calciphylaxis is very rare but has a mortality rate of 69% within 6 months. Its treatment is controversial. For small lesions, conservative treatment with local wound care and debridement may suffice. Partial or complete penectomy may be needed for more extensive lesions, and especially those associated with signs of local infection. In addition to surgical intervention, as with any other case of calcific uremic arteriolopathy, the cornerstones of therapy should be to keep serum phosphorus <6 mg/dL, and a Ca × P product <55 mg²/dL². We report here the first case of penile calciphylaxis whereby intravenous sodium thiosulfate was used in addition to the standard medical and surgical therapy. Two months after surgery, the patient's wound completely healed and he has experienced no new lesions over the past 11 months.
Sandhu
Gagangeet
G
Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY, USA. gsandhu@chpnet.org
Gini
Marcelo Barrios
MB
Ranade
Aditi
A
Djebali
David
D
Smith
Steven
S
D002115:Calciphylaxis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002118:Calcium / Q000378:metabolism; D002614:Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010409:Penile Diseases / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010758:Phosphorus / Q000097:blood; D013885:Thiosulfates / Q000008:administration & dosage / Q000627:therapeutic use*
D002614:Chelating Agents; D013885:Thiosulfates; D010758:Phosphorus; C017717:sodium thiosulfate; D002118:Calcium