Calciphylaxis — Are We Missing the Diagnosis? Case-Based Review

Calciphylaxis is a calcific uraemic arteriolopathy that is observed in patients with end-stage renal disease. Its pathophysiology remains uncertain. The end result is calcium deposition in the medial layer of small-sized arteries and arterioles leading to painful skin ulcers. Approximately half of the patients die within a year of diagnosis with sepsis being the commonest cause. Treatment options are limited. However, intravenous sodium thiosulphate and bisphosphonates seem to be successful in controlling the disease progression in some cases. Wound care and surgical debridement remain the main stay of prevention of secondary infections. We share our experience with three cases over the past year, the need to keep this differential diagnosis in mind when treating lesions that appear “ischemic” and suggest an algorithm for diagnosis and management.