Calciphylaxis with evidence of hypercoagulability successfully treated with unfractionated heparin: a multidisciplinary approach.
Calciphylaxis is characterized by abnormal calcification of vessels and skin; however, its aetiology and pathogenesis remain unclear. Entities frequently associated with calciphylaxis are end-stage renal disease, diabetes mellitus, hypercalcaemia, hyperphosphataemia, elevated calcium-phosphate product, hyperparathyroidism and possible hypercoagulable states. Skin lesions may remain quiescent or may develop suddenly and progress rapidly. They are more common on the legs. Treatment of calciphylaxis is very challenging and requires interdisciplinary management. We present a case that highlights the difficulty of treating calciphylaxis. A multidisciplinary approach was vital for the proper treatment of our patient. This case also demonstrates the importance of searching for underlying hypercoagulable states, especially in recalcitrant cases. In cases of calciphylaxis with vessel occlusion from microthrombi, heparin therapy would be a logical next step. The effect of anticoagulation may be rapid and impressive.
Department of Dermatology, New York Medical College, New York, NY, USA.
A
A
Carter
Department of Dermatology, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA.
A G
AG
Ortega-Loayza
Department of Internal Medicine, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA.
J
J
Barrett
Department of Dermatology, Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA, USA.
J
J
Nunley
D000925:Anticoagulants / Q000627:therapeutic use*; D002115:Calciphylaxis / Q000188:drug therapy*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007866:Leg; D008875:Middle Aged; D012875:Skin Diseases, Metabolic / Q000188:drug therapy*; D019851:Thrombophilia / Q000188:drug therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin