Reactions 1680, p237 - 2 Dec 2017 Calciphylaxis: case report A 60-year-old man developed calciphylaxis following treatment with ergocalciferol, sevelamer, calcium carbonate and prednisone [time to reaction onsets and outcomes not stated; not all indications and routes stated]. The man, who had a history of end stage renal disease, had been receiving ergocalciferol 50,000 units weekly, sevelamer 3,200mg three times daily and calcium carbonate 500mg three times a day along with various other concomitant medications. He was also using dabigatran etexilate [dabigatran] as an off label therapy. Subsequently, he developed severe tertiary hyperparathyroidism. In January 2015, he underwent subtotal parathyroidectomy due to continued elevation in intact parathyroid hormone (iPTH) levels. After parathyroidectomy, his iPTH levels reduced to 184 pg/mL. Approximately 4 weeks after the parathyroidectomy, he developed indurated nodules leading to painful necrotic skin lesions in lower extremities and buttocks. In March 2015, a skin biopsy of the lesions revealed calciphylaxis. Therefore, the man’s scheduled haemodialysis duration was increased. He received IV sodium thiosulfate [sodium thiosulphate] 25g with each dialysis sessions, which was considered to be an off label use. He was constantly in hypocalcaemic state and required high vitamin-D and calcium supplements. His pain was controlled by gabapentin, opioids, lidocaine and oral prednisone. His wound care management included debridement and antibiotics. In spite of all these treatments, his condition deteriorated due to sepsis from a recurrent wound infection. Eventually, he passed away in October 2015 [cause of death not stated]. Author comment: "Hyperphosphatemia, medications including warfarin, calcium-based binders, vitamin D analogs, steroids, female gender, caucasian race, obesity (BMI>30), hypercoagulable states such as protein C and S deficiency and antiphospholipid syndrome, hypoalbuminemia, DM, longer dialysis vintage (>6–7 years), and inflammatory and autoimmune conditions are associated risk factors." Karmegam S, et al. Calciphylaxis after parathyroidectomy. Hemodialysis International 21: S62-S66, Oct 2017. Available from: URL: http:// doi.org/10.1111/hdi.12599 - USA 803284485 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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