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Case Report: Refractory Calciphylaxis in Lupus

Joey Kim, MD, Navneet Kaur, MD, Phillip Zhang, MD, & Irene Blanco, MD, MS  |  Issue: May 2018  |  May 17, 2018

Hopefully, this case report not only raises awareness of the condition, but helps clinicians facing similar challenges.


Joey Kim, MD, is a second-year rheumatology fellow at the Montefiore Medical Center in New York City.

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Navneet Kaur, MD, is a second-year internal medicine resident at the Jacobi Medical Center in New York City.

Phillip Zhang, MD, is a third-year internal medicine resident at the Montefiore Medical Center in New York City.

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Irene Blanco, MD, MS, is an associate professor of Medicine and the Rheumatology Fellowship Program director at the Albert Einstein College of Medicine in New York City.

References

  1. Janigan DT, Hirsch DJ, Klassen GA, et al. Calcified subcutaneous arterioles with infarcts of the subcutis and skin (“calciphylaxis”) in chronic renal failure. Am J Kidney Dis. 2000 Apr;35(4):588–597.
  2. Nigwekar SU, Wolf M, Sterns RH, et al. Calciphylaxis from nonuremic causes: A systematic review. Clin J Am Soc Nephrol. 2008 Jul;3(4):1139–1143.
  3. Lee JL, Naguwa SM, Cheema G, et al. Recognizing calcific uremic arteriolopathy in autoimmune disease: An emerging mimicker of vasculitis. Autoimmun Rev. 2008 Sep;7(8):638–643.
  4. Aliaga LG, Barreira JC. Calciphylaxis in a patient with systemic lupus erythematosus without renal insufficiency or hyperparathyroidism. Lupus. 2012 Mar;21(3):329–331.
  5. Hafner J, Keusch G, Wahl C, et al. Uremic small-artery disease with medial calcification and intimal hyperplasia (so-called calciphylaxis): A complication of chronic renal failure and benefit from parathyroidectomy. J Am Acad Dermatol. 1995 Dec;33(6):954–962.
  6. Price PA, Omid N, Than TN, et al. The amino bisphosphonate ibandronate prevents calciphylaxis in the rat at doses that inhibit bone resorption. Calcif Tissue Int. 2002 Oct;71(4):356–363.
  7. Weenig RH. Pathogenesis of calciphylaxis: Hans Selye to nuclear factor kappa-B. J Am Acad Dermatol. 2008 Mar;58(3):458–471.
  8. Mochel MC, Arakaki RY, Wang G, et al. Cutaneous calciphylaxis: retrospective histopathologic evaluation. Am J Dermatopathol. 2013 Jul; 35(5):582–586.
  9. Paul S, Rabito CA, Vedak P, et al. The role of bone scintigraphy in the diagnosis of calciphylaxis. JAMA Dermatol. 2017 Jan 1;153(1):101–103.
  10. Yu Z, Gu L, Pang H, et al. Sodium thiosulfate: An emerging treatment for calciphylaxis in dialysis patients. Case Rep Nephrol Dial. 2015 Mar 13;5(1):77–82.
  11. Pasch A, Schaffner T, Huynh-Do U, et al. Sodium thiosulfate prevents vascular calcifications in uremic rats. Kidney Int. 2008 Dec;74(11):1444–1453.
  12. Nigwekar SU, Brunelli SM, Meade D, et al. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol. 2013 Jul;8(7):1162–1170.
  13. Hackett BC, McAleer MA, Sheehan G, et al. Calciphylaxis in a patient with normal renal function: Response to treatment with sodium thiosulfate. Clin Exp Dermatol. 2009 Jan;34(1):39–42.
  14. Monney P, Nguyen QV, Perroud H, et al. Rapid improvement of calciphylaxis after intravenous pamidronate therapy in a patient with chronic renal failure. Nephrol Dial Transplant. 2004 Aug;19(8):2130–2132.
  15. Shiraishi N, Kitamura K, Miyoshi T, et al. Successful treatment of a patient with severe calcific uremic arteriolopathy (calciphylaxis) by etidronate disodium. Am J Kidney Dis. 2006 Jul;48(1):151–154.
  16. Lorriaux A, Chaby G, Dhaille F, et al. Nonuraemic calciphylaxis: Response to treatment with pamidronate and negative pressure therapy. Clin Exp Dermatol. 2015 Jan;40(1):52–55.
  17. Hasegawa J, Nagashima M, Yamamoto M, et al. Bone resorption and inflammatory inhibition efficacy of intermittent cyclical etidronate therapy in rheumatoid arthritis. J Rheumatol. 2003 Mar;30(3):474–479.
  18. Sharma A, Burkitt-Wright E, Rustom R. Cinacalcet as an adjunct in the successful treatment of calciphylaxis. Br J Dermatol. 2006 Dec;155(6):1295–1297.
  19. Tibbles PM, Edelsberg JS. Hyperbaric-oxygen therapy. N Engl J Med. 1996 Jun 20;334(25):1642–1648.
  20. An J, Devaney B, Ooi KY, et al. Hyperbaric oxygen in the treatment of calciphylaxis: A case series and literature review. Nephrology (Carlton). 2015 Jul;20(7):444–450.

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Filed under:Systemic Lupus Erythematosus Tagged with:calciphylaxisconnective tissue diseaseSystemic lupus erythematosus

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