Category: Clinical Sciences/Health Conditions
A 62 year-old female with a past medical history of Chronic Kidney Disease stage 4, uncontrolled Diabetes Mellitus Type 2, chronic bilateral venous stasis, and chronic deep venous thrombosis, recently transitioned from Warfarin to Apixaban, presented with large distal lower extremity wounds concerning for calciphylaxis. She was admitted to inpatient rehabilitation for initiation of hemodialysis along with local wound care with a bioengineered living cell therapy skin substitute.
The patient was evaluated by plastic surgery but was not a skin graft candidate due to significant contractures of the peripheral wound edges. Calcium alginate dressings were placed on the wounds for one week, followed by placement of a bioengineered skin substitute. She underwent further compression therapy with self-adherent wraps and tubular bandages to decrease venous congestion in the lower limbs. Intravenous Sodium Thiosulfate was started during hemodialysis sessions for calciphylaxis treatment. Furthermore, aggressive diuresis with Bumetanide and Chlorthalidone was started to reduce surrounding limb edema. She was referred for outpatient parathyroidectomy and continued local wound care with debridement to improve granulation.
Calciphylaxis results from a reduction in arteriolar blood flow due to calcification, fibrosis, and thrombus formation. Medial vessel calcification occurs, followed by vascular endothelial injury causing tissue infarction. This case exemplifies an effective multi-interventional strategy to treat calciphylaxis caused by widespread angiopathy and chronic inflammation. Effective management includes aggressive diuresis and administration of sodium thiosulfate, along with weekly wound care management to facilitate prompt wound healing.
Calciphylaxis is a serious disease in which calcium accumulates in small blood vessels of fat and skin tissues. It causes blood clots, painful skin ulcers, and can cause widespread infection. The risk of calciphylaxis increases in the setting of End Stage Renal Disease, secondary hyperparathyroidism, and chronic Warfarin therapy. This case highlights success in wound healing from local wound care and systemic sodium thiosulfate.