Calciphylaxis presenting as digital ischemia

Excerpt

A 31-year-old woman with end-stage renal disease (ESRD) secondary to membranoproliferative glomerulonephritis presented with gradually worsening severe right hand pain that started during hemodialysis. Physical examination revealed livedo reticularis present on the right hand along with cyanotic digits, and a peri-ungal eschar on the third digit (Fig. 1a). Decreased right radial and ulnar pulses were present. The initial phosphorous level was 8.5 mg/dL. The patient had been hyperphosphatemic for several years prior to presentation. An arterial doppler study with duplex of the right hand was negative for a thrombus but revealed diminished waveforms in the digits. A right hand X-ray study showed vascular calcifications of both the radial and ulnar arteries and soft tissue calcifications along the digits (Fig. 1b). A skeletal survey revealed extensive soft tissue, and vascular calcifications of the bilateral calves and distal common carotid arteries (Fig. 1c). She was diagnosed with calcific uremic arteriolopathy (CUA), and started on sodium thiosulfate during dialysis.

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