BACKGROUND
Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of
calciphylaxis leading to lower gastrointestinal (GI)
bleeding and rectal ulceration of the GI mucosa. CASE REPORT A 66-year-old woman with past medical history of
diabetes mellitus,
hypertension,
end-stage renal disease (
ESRD), recently diagnosed
ovarian cancer, and on
hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI
bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal
necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive
vascular calcifications. Recurrent episodes of profuse GI
bleeding were managed conservatively with
blood transfusion as needed. Following her diagnosis of
calciphylaxis, supplementation with
vitamin D and
calcium containing
phosphate binders was stopped. She was started on daily
hemodialysis with low
calcium dialysate bath as well as intravenous
sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. CONCLUSIONS
Calciphylaxis leading to intestinal
ischemia/perforation should be considered in the differential diagnosis in
ESRD on HD presenting with
abdominal pain or GI
bleeding.