title: Subcutis calcinosis caused by injection of calcium-containing heparin in a chronic kidney injury patient.
abstract: Subcutis calcinosis, characterized by abnormal calcium deposits in the skin, is a rare complication of using calcium-containing heparin occurring in patients with advanced renal failure. We report the case of an 83-year-old female, a known case of chronic kidney disease (CKD) for four years with recent worsening of renal failure requiring hospitalization and hemodialysis. She developed subcutis calcinosis following injection of calcium-containing heparin. Biochemical tests showed serum parathormone level at 400 pg/dL, hypercalcemia, elevated calcium-phosphate product and monoclonal gammopathy related to multiple myeloma. She developed firm subcutaneous nodules in the abdomen and the thighs, the injection sites of Calciparin ® (calcium nadroparin) that was given as a preventive measure against deep vein thrombosis. The diagnosis of subcutis calcinosis was confirmed by the histological examination showing calcium deposit in the dermis and hypodermis. These lesions completely disappeared after discontinuing calcium nadroparin injections. Subcutis calcinosis caused by injections of calcium-containing heparin is rare, and, to the best our knowledge, not more than 12 cases have been reported in the literature. Pathogenesis is not well established but is attributed to the calcium disorders usually seen in advanced renal failure. Diagnosis is confirmed by histological tests. Outcome is mostly favorable. The main differential diagnosis is calciphylaxis, which has a poor prognosis. Even though rarely reported, we should be aware that CKD patients with elevated calcium-phosphorus product can develop subcutis calcinosis induced by calcium-containing heparin. When it occurs, fortunately and unlike calciphylaxis, outcome is favorable.
authors.affiliation: Department of Nephrology, La Rabta Hospital, Tunis, Tunisia.
authors.forename: Lilia Ben
authors.initials: LB
authors.lastname: Fatma
authors.forename: Zohra
authors.initials: Z
authors.lastname: El Ati
authors.forename: Haifa
authors.initials: H
authors.lastname: Azzouz
authors.forename: Lamia
authors.initials: L
authors.lastname: Rais
authors.forename: Madiha
authors.initials: M
authors.lastname: Krid
authors.forename: Wided
authors.initials: W
authors.lastname: Smaoui
authors.forename: Hédi Ben
authors.initials: HB
authors.lastname: Maiz
authors.forename: Soumaya
authors.initials: S
authors.lastname: Béji
authors.forename: Karim
authors.initials: K
authors.lastname: Zouaghi
authors.forename: Moncef
authors.initials: M
authors.lastname: Zitouna
authors.forename: Fatma Ben
authors.initials: FB
authors.lastname: Moussa
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002114:Calcinosis / Q000139:chemically induced* / Q000175:diagnosis; D002115:Calciphylaxis; D002118:Calcium / Q000097:blood; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007279:Injections, Subcutaneous; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012871:Skin Diseases / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D010758:Phosphorus; C006871:calcium heparin; D006493:Heparin; D002118:Calcium