title: An unusual site for calciphylaxis: a case report.
abstract: BACKGROUND
  Calciphylaxis is a rare condition characterized by calcification of the tunica media of small arteries with or without endovascular fibrosis, extravascular calcification and vascular thrombosis, leading to tissue ischemia and hence necrosis of tissues supplied by respective vessel.
  
  
  METHODS
  An 83-year-old lady presented with a 2-week history of rapidly progressing painful necrotic vulval lesion. This patient was being treated medically with bisphosphonates for mild hypercalcaemia secondary to a parathyroid adenoma. The diagnosis of calciphylaxis was made by biopsy of lesion, revealing extensive necrotic areas and multiple abscesses with numerous thrombosed and calcified blood vessels.
  
  
  CONCLUSIONS
  This case shows an unusual presentation of calciphylaxis, in a patient with primary hyperparathyroidism, in the absence of end stage renal failure. The pathogenesis of the condition is still relatively unknown. Particularly of note in this case is the presentation of the lesion 9 months after the start of treatment with bisphosphonate after the relative decrease of serum parathyroid levels and serum calcium levels. This leads to the question of initiation of the pathology - did the bisphosphonate treatment have an input in initiation of the lesion? The case under review adds a new differential diagnosis to necrotic vulval lesions, other than malignancy.
authors.affiliation: Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta.
authors.forename: Martina
authors.initials: M
authors.lastname: Muscat
authors.forename: Mark
authors.initials: M
authors.lastname: Brincat
authors.forename: James
authors.initials: J
authors.lastname: Degaetano
authors.forename: Josanne
authors.initials: J
authors.lastname: Vassallo
authors.forename: Jean
authors.initials: J
authors.lastname: Calleja-Agius
mesh_terms: D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D002114:Calcinosis / Q000209:etiology; D002115:Calciphylaxis / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000188:drug therapy; D009336:Necrosis; D013927:Thrombosis / Q000209:etiology; D014844:Vulva / Q000098:blood supply / Q000473:pathology*; D014845:Vulvar Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates