SHM Converge Scientific Abstract ePoster Gallery-A Dangerous Cycle: Non-Adherence and Calciphylaxis

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This case describes a 42-year-old man with ESRD on hemodialysis, hypertension, anemia of chronic disease, renal osteodystrophy, and known right wrist calciphylaxis who presented with worsening erythema and bleeding from the wrist wound. His course was complicated by repeated non-adherence to dialysis, leading to multiple admissions for volume overload and likely worsening disease progression.<br /><br />On exam, the wrist lesion showed ulceration, necrosis, and active bleeding. He was treated empirically with vancomycin and meropenem for suspected infected calciphylaxis. Hemostasis required suture ligation. Wound cultures were nonspecific, and he completed 10 days of vancomycin and ceftazidime before discharge. Despite treatment, he had recurrent hospitalizations over the next three months and eventually required right wrist amputation at a tertiary center due to osteomyelitis and uncontrolled pain.<br /><br />The discussion explains that calciphylaxis is a severe ESRD-associated skin disorder caused by calcification of arterioles and small arteries, leading to tissue ischemia and painful skin lesions. Once lesions ulcerate, they carry high morbidity and mortality, especially when infected. Standard treatment includes sodium thiosulfate, which binds calcium and reactive oxygen species. Surgical management is generally reserved for infected wounds, and outcomes data are limited. Because calciphylaxis affects multiple systems and causes severe nociceptive and neuropathic pain, care requires a multidisciplinary approach. In this patient, even multimodal pain control was insufficient, and amputation became necessary.<br /><br />Overall, the case highlights how calciphylaxis can lead to devastating complications in ESRD, and how non-adherence to dialysis can worsen outcomes significantly.

Asset Subtitle

Ashok Biju

Meta Tag

Author List Ashok Biju, Elizabeth Cho, James Maserejian, Samyuth Subramanian

Category Clinical Vignettes

Concept Calciphylaxis

Concept End-stage Kidney Disease

Concept Ulceration

Concept Infection

Concept Osteomyelitis

Distinguished Non-Finalist

Presenter Organization Indiana University Southwest Internal Medicine Residency

Presenting Author Ashok Biju

Track Adult

Keywords

calciphylaxis

end-stage renal disease

hemodialysis

wrist ulcer

skin necrosis

wound infection

osteomyelitis

amputation

dialysis nonadherence

sodium thiosulfate

Calciphylaxis

End-stage Kidney Disease

Ulceration

Infection

Osteomyelitis