title: Calciphylaxis in a morbidly obese woman with rheumatoid arthritis presenting with severe weight loss and vitamin D deficiency.
abstract: OBJECTIVE
  To present an unusual case of calciphylaxis in an obese patient with inactive rheumatoid arthritis and normal renal function.
  
  
  METHODS
  We describe a 46-year-old morbidly obese Caucasian woman who had previously weighed 200 kg and presented with painful leg ulcers following a rapid weight loss of 102 kg in 1 year.
  
  
  RESULTS
  The subject was admitted with a 6-week history of painful leg ulcers that progressed to her thighs. Vasculitis and active rheumatoid arthritis were excluded clinically and biochemically. A skin biopsy confirmed calciphylaxis in the context of normal renal function. Serum 25-hydroxyvitamin D was low at 14 ng/mL (reference range, 20 to 200 ng/mL), with an elevated serum parathyroid hormone level of 241 pg/mL (reference range, 10 to 65 pg/mL), but normal serum calcium and phosphorus levels. The skin lesions persisted despite local wound care, daily hyperbaric oxygen, and parenteral sodium thiosulfate therapies. After normalizing the serum vitamin D level through oral supplementation, she responded well to pamidronate infusion with complete healing of the ulcers and regained 13% of her premorbid weight.
  
  
  CONCLUSIONS
  This is the first case of calciphylaxis preceded by weight loss of greater than 100 kg in a patient with hypovitaminosis D who responded to pamidronate therapy.
authors: Department of Endocrinology and Diabetes, The Townsville Hospital, Douglas, Australia. umalabu@yahoo.com
authors: Usman H
authors: UH
authors: Malabu
authors: Lynden J
authors: LJ
authors: Roberts
authors: Kunwarjit S
authors: KS
authors: Sangla
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications*; D002115:Calciphylaxis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism / Q000473:pathology*; D014808:Vitamin D Deficiency / Q000150:complications / Q000473:pathology*; D015431:Weight Loss / Q000502:physiology*