title: Development of multiorganic calciphylaxis during teriparatide, vitamin D, and calcium treatment.
abstract: Non-uremic calciphylaxis is a severe rare disorder characterized by ischemic necrosis. Recently, three cases of cutaneous calciphylaxis have been described in the context of teriparatide treatment. We present a 51-year-old woman with alcoholic cirrhosis who developed multiorganic calciphylaxis shortly after starting teriparatide treatment associated with calcium and 25-hydroxyvitamin D supplements for severe osteoporosis. After lengthy care of the infectious complications and treatment with bisphosphonates and sodium thiosulfate progressive improvement was observed over a 3-year period. The time between the initiation of teriparatide and the development of calciphylaxis suggests that this agent may have been the triggering factor of this process. Nevertheless, other non-negligible risk factors for calciphylaxis such as alcoholic liver disease, obesity, and vitamin D treatment must also be considered in this patient. Considering the severity of this extremely rare clinical condition, better knowledge of the risk factors related to calciphylaxis development is mandatory.
authors.affiliation: Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain. amonegal@clinic.ub.es.
authors.forename: A
authors.initials: A
authors.lastname: Monegal
authors.affiliation: Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Peris
authors.affiliation: Department Dermatology, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alsina
authors.affiliation: Department of Hepatology Unit, Hospital Clínic. CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Colmenero
authors.affiliation: Department of Rheumatology, Hospital Clínic. CIBERehd, University of Barcelona, C/Villarroel 170, Barcelona, 08036, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Guañabens
mesh_terms: D002115:Calciphylaxis / Q000139:chemically induced*; D002118:Calcium / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019379:Teriparatide / Q000008:administration & dosage / Q000009:adverse effects*; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D019379:Teriparatide; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium
keywords: Calciphylaxis; Multiorganic; Non-uremic; Teriparatide; Vitamin D