title: Successful Management of Calciphylaxis in a Kidney Transplant Patient: Case Report.
abstract: Calciphylaxis is a rare and often fatal condition mostly associated with end-stage renal disease. The pathophysiology remains elusive and treatment options are scarce. We present a rare case of severe calciphylaxis after kidney transplantation in a patient with persistent hyperparathyroidism.
  
  
  METHODS
  A 78-year-old man with a history of end-stage renal disease developed edema and ulcerations on both lower limbs 14 months after kidney transplantation while receiving an mammalian target of rapamycin inhibitor to manage polyoma virus-associated nephropathy. Skin biopsies taken from the ulcerations confirmed calciphylaxis. A multimodal treatment regimen combining medical (calcium-free phosphate binders, cinacalcet, paricalcitol, sodium thiosulfate, antibiotic treatment) and surgical treatments (debridement and autologous skin transplantation) ultimately resulted in successful wound healing.
  
  
  CONCLUSIONS
  We describe a case of severe calciphylaxis in a nonuremic patient after kidney transplantation. Rapid diagnosis by skin biopsy and an aggressive multimodal therapy regimen followed by long-term oral sodium thiosulfate treatment were crucial factors for a favorable outcome.
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Thomas
authors: T
authors: Welte
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Frederic
authors: F
authors: Arnold
authors: Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
authors: Kristin
authors: K
authors: Technau-Hafsi
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Elke
authors: E
authors: Neumann-Haefelin
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Rika
authors: R
authors: Wobser
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Stefan
authors: S
authors: Zschiedrich
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.; Center for Biological Signaling Studies (BIOSS), Freiburg, Germany.
authors: Gerd
authors: G
authors: Walz
authors: Renal Division, University Medical Center Freiburg, Freiburg, Germany.
authors: Albrecht
authors: A
authors: Kramer-Zucker