SHM Converge Scientific Abstract ePoster Gallery-The Antibiotic-Resistant "Cellulitis": Calciphylaxis in the Critically Ill Patient

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A 47-year-old woman with obesity, diabetes, hypertension, and cirrhosis presented in septic shock from Enterobacter cloacae bacteremia and developed acute renal failure with fluid overload and respiratory failure, requiring transfer for hemodialysis and ongoing broad-spectrum antibiotics. She was initially treated with ertapenem and vancomycin, but renal dysfunction progressed, and during dialysis she developed a new erythematous rash on her left medial thigh. Because of her body habitus, the area was difficult to examine, and the rash was presumed to be cellulitis.<br /><br />Despite treatment with doxycycline and ertapenem, the rash did not improve. CT imaging showed soft tissue edema without abscess, and an extensive rheumatologic evaluation was unrevealing. The lesion later became a painful ulcer with a necrotic border and additional smaller ulcers. A skin biopsy performed about two weeks after the rash first appeared confirmed calciphylaxis.<br /><br />She was started on sodium thiosulfate, cilostazol, and meticulous wound care, with plans for reassessment if there was insufficient improvement. The case highlights how calciphylaxis can mimic cellulitis, especially in critically ill patients with renal failure on dialysis. Early recognition is important because calciphylaxis carries high mortality, is prone to secondary infection, and requires prompt wound care and infection precautions. The report also emphasizes antibiotic stewardship, since misdiagnosis can lead to unnecessary exposure to broad-spectrum antibiotics.

Asset Subtitle

Leah Hite

Meta Tag

Author List Kashif Khan, Leah Hite

Category Clinical Vignettes

Concept Calciphylaxis

Concept Renal Failure

Concept Dialysis

Concept End-stage Kidney Disease

Concept Skin Lesion

Distinguished Non-Finalist

Presenter Organization The Ohio State University College of Medicine

Presenting Author Leah Hite

Track Adult

Keywords

calciphylaxis

cellulitis

renal failure

hemodialysis

septic shock

Enterobacter cloacae

skin biopsy

necrotic ulcer

sodium thiosulfate

antibiotic stewardship

Calciphylaxis

Renal Failure

Dialysis

End-stage Kidney Disease

Skin Lesion