Case Report
Calciphylaxis precipitated by ultraviolet light in a patient with end-stage renal disease secondary to systemic lupus erythematosus

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Abstract

Calciphylaxis is a rare and severe calcification syndrome described mainly in patients with end-stage renal disease (ESRD) undergoing dialysis or with a renal transplant. This life-threatening condition is characterized by the abrupt onset of painful ischemic skin ulcers and necrosis. Secondary local and systemic infection may supervene and, without timely and appropriate interventions, calciphylaxis may be fatal. A precipitant or challenging agent is believed to be necessary to initiate the process. We describe a case of a woman with ESRD receiving continuous ambulatory peritoneal dialysis who developed calciphylaxis in the setting of severe hyperparathyroidism after receiving UV photoradiation therapy. We suggest that the UV light served as the challenging agent in the precipitation of this devastating condition.

Section snippets

Case report

A 39-year-old woman with end-stage renal disease (ESRD) secondary to SLE presented in 1997 with a 2- to 3-week history of bilateral thigh pain.

In 1978, this patient first presented with encephalopathy, psychosis, and stroke syndrome. She had a prolonged hospitalization course (including 1 month in the intensive care unit), marked by an acute myocardial infarction and acute renal failure requiring renal replacement therapy. A renal biopsy was nondiagnostic. She received CAPD for 3 years, then

Discussion

Although the exact mechanism underlying the development of calciphylaxis remains to be clarified, the experimental work of Selye et al1, 2 has significantly contributed to the knowledge thus far. More recently, a review of nine patients with proximal calciphylaxis6 identified high body mass index, low serum albumin level, and white race as risk factors for calciphylaxis.

Our patient with ESRD and secondary hyperparathyroidism developed topical lesions associated with severe pain, hyperesthesia,

References (25)

  • H Selye

    Calciphylaxis

    (1962)
  • HJ Androgue et al.

    Systemic calciphylaxis revisited

    Am J Nephrol

    (1981)
  • Cited by (0)

    Address reprint requests to Joanne M. Bargman, MD, Associate Professor of Medicine, University of Toronto, Staff Nephrologist, Toronto General Hospital, 200 Elizabeth St, 10EN-216, Toronto, Ontario, Canada M5G 2C4. E-mail: [email protected]

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