title: Successful treatment of calciphylaxis by a multidisciplinary approach.
abstract: A 48-year-old woman performing peritoneal dialysis for end-stage renal disease presented with a painful leg ulcer. The investigation revealed an elevated parathyroid hormone level and the histological examination of the biopsy tissue from the ulcer revealed medial calcification of the arterioles, consistent with calciphylaxis. The patient developed additional ulcers in the lower limbs and treatment with antibiotics, cinacalcet, sevelamer, sodium thiosulfate, low calcium dialysate and hyperbaric oxygen therapy was instituted. The patient had a favourable outcome and after 9 months the ulcers had healed and the parathyroid hormone level reached the normal range. Calciphylaxis is a rare and life-threatening disorder associated with a mortality of 60-80%. Its pathogenesis is not fully understood hence there is no consensus in the treatment of this pathology.
authors.affiliation: Department of Vascular Surgery, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
authors.forename: Lisa
authors.initials: L
authors.lastname: Borges
authors.affiliation: Hyperbaric Medicine Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Rosa
authors.affiliation: Department of Angiology and Vascular Surgery, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Dias
authors.affiliation: Department of Angiology and Vascular Surgery, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cássio
mesh_terms: D002115:Calciphylaxis / Q000139:chemically induced / Q000473:pathology* / Q000628:therapy; D002614:Chelating Agents; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007871:Leg Ulcer / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009281:Naphthalenes; D010281:Parathyroid Hormone / Q000378:metabolism*; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011073:Polyamines; D000069603:Sevelamer; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D011073:Polyamines; D000069603:Sevelamer; D000069449:Cinacalcet