Curious case of calciphylaxis leading to acute mitral regurgitation.
Calciphylaxis is uncommon and typically seen in patients with end-stage renal disease. It has been defined as a vasculopathic disorder characterised by cutaneous ischaemia and necrosis due to calcification, intimal fibroplasia and thrombosis of pannicular arterioles. We present the case of a 74-year-old woman with chronic kidney disease stage III who developed calciphylaxis leading to mitral valve calcification, chordae tendineae rupture and acute mitral regurgitation. Although an alternative explanation can typically be found for non-uraemic calciphylaxis, her evaluation did not reveal any usual non-uraemic causes including elevated calcium-phosphorus product, hyperparathyroidism, or evidence of connective tissue disease. Her wounds improved with sodium thiosulfate, pamidronate, penicillin and hyperbaric oxygen therapies but she ultimately decompensated with the onset of acute mitral regurgitation attributed to rupture of a previously calcified chordae tendineae. This case highlights an unusual case of calciphylaxis without clear precipitant as well as a novel manifestation of the disease.
Department of Internal Medicine, Keesler Medical Center, Biloxi, Mississippi, USA.
Grant Gardner
GG
Gallimore
Blair
B
Curtis
Andria
A
Smith
Michael
M
Benca
D000368:Aged; D001707:Biopsy, Needle; D002115:Calciphylaxis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D002405:Catheterization, Central Venous; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000473:pathology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler; D017809:Fatal Outcome; D005260:Female; D006341:Heart Rupture / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed