SHM Converge Scientific Abstract ePoster Gallery-Rash of Rarity: An Unexpected Inpatient Presentation of Calciphylaxis

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A 50-year-old woman with CKD5, cervical cancer, and severe peripheral arterial disease was admitted with septic shock, pneumonia, renal failure, hyponatremia, and severe acidosis. She improved after ICU care, antibiotics, and emergent hemodialysis, then transferred to the general medicine floor.<br /><br />On hospital day 5, she developed sudden severe bilateral thigh pain with new symmetric retiform purpuric plaques and patches. Dermatology and vascular surgery were consulted, and CT angiography showed no vascular occlusion. Over the next several days, the rash rapidly progressed to the breasts and right forearm. Pain control required a hydromorphone PCA.<br /><br />A skin biopsy on day 11 confirmed calciphylaxis with calcium deposition in small vessels of the subcutis and deep dermis. Her course was then complicated by persistent severe pain and poor tolerance of hemodialysis. After prolonged hospitalization, she was discharged to inpatient hospice.<br /><br />The case highlights calciphylaxis, a rare and often fatal condition caused by subcutaneous arteriolar calcification leading to ischemia, severe pain, and nonhealing skin lesions. It typically affects areas with more adipose tissue and may progress over weeks to months, though this patient’s presentation was unusually rapid. Major risk factors include end-stage renal disease, malignancy, and autoimmune disease. Diagnosis is confirmed by biopsy, often with Von Kossa stain.<br /><br />Key lessons: consider calciphylaxis in any patient with rapidly progressive, painful purpuric rash in fatty areas, especially with CKD or ESRD. Early dermatology consultation for biopsy is essential. Management should prioritize pain control, wound care, specialist involvement, and early goals-of-care discussions, since available treatments have limited success and mortality remains high.

Asset Subtitle

Jessica Cristallo

Meta Tag

Author List Jessica Cristallo, Sarah A. Tupchong

Category Clinical Vignettes

Concept Calciphylaxis

Concept Chronic Kidney Disease

Concept End-stage Kidney Disease

Concept Retiform Purpura

Concept Skin Biopsy

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Jessica Cristallo

Track Adult

Keywords

calciphylaxis

end-stage renal disease

chronic kidney disease

painful purpuric rash

subcutaneous arteriolar calcification

skin biopsy

hemodialysis

septic shock

malignancy

inpatient hospice

Calciphylaxis

Chronic Kidney Disease

End-stage Kidney Disease

Retiform Purpura

Skin Biopsy