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Published in: European Journal of Plastic Surgery 3/2018

01-06-2018 | Case Report

Non-uraemic calciphylaxis: a diagnostic and management challenge for the burns team

Authors: Jonathan Cubitt, Anthony Short, Linsday Shanks, Allan Dawson, Claire Ware, Peter Drew, David Williams

Published in: European Journal of Plastic Surgery | Issue 3/2018

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Abstract

Calciphylaxis is a rare systemic condition usually seen in patients with end-stage renal disease. It is characterised by pathological calcification of dermal blood vessels, causing ischaemia and necrosis in the skin and subcutaneous fat. The lesions are usually small but, in extreme cases, may be very extensive and may mimic necrotising fasciitis, prompting extensive surgical debridement. We describe the challenges faced in managing such a case. A 38-year-old female patient was admitted to another hospital with widespread progressive truncal skin necrosis. A provisional diagnosis of necrotising fasciitis was made, and she underwent debridement of 32% of her total body surface area (TBSA). However, her condition rapidly deteriorated and she was transferred to our burn centre for further management. Diagnosis of calciphylaxis was based on clinical features and confirmed by tissue biopsy. Characteristic findings of progressive skin and fat necrosis at the wound margins with healthy underlying fascia and muscle were recognised from previously treated cases of calciphylaxis; however, the absence of renal disease proved misleading. Non-uraemic calciphylaxis is very rare but can, as in this case, be associated with alcoholic liver disease. At our centre, the patient required prolonged ventilation and supportive treatment in burns critical care, combined with intensive wound management, repeated episodes of debridement, temporary wound cover using human skin allografts and reconstruction using split-thickness autograft. We report this case to alert others to this rare condition as a possible diagnosis in patients presenting with extensive panniculitis. We discuss associations, diagnostic difficulties, novel therapies and the importance of multidisciplinary care in managing these complex cases.
Level of evidence: Level V, diagnostic study.
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Metadata
Title
Non-uraemic calciphylaxis: a diagnostic and management challenge for the burns team
Authors
Jonathan Cubitt
Anthony Short
Linsday Shanks
Allan Dawson
Claire Ware
Peter Drew
David Williams
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 3/2018
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-017-1358-z

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