When Calciphylaxis isn’t the Answer: Diagnostic Delay in an End Stage Renal Disease Patient with Severe Necrotic Wounds
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Publication Date
2025
Abstract
Introduction: •Polyarteritis nodosa (PAN) is a necrotizing vasculitis that primarily affects medium-sized vessels, and less commonly small vessels •Skin findings in PAN include purpura, livedoid lesions, subcutaneous nodules, and necrotic ulcers. •Calciphylaxis is a syndrome of calcium deposition in the micro vessels of subcutaneous adipose tissue and dermis that results in painful skin lesions. •Skin findings in calciphylaxis may include induration, plaques, nodules, livedo, and purpura that progress to ulcers and black eschar. •Skin findings in calciphylaxis are a known mimic to PAN. Case Description: •50-year-old African American woman with history of end-stage renal disease (ESRD) and type-2 diabetes mellitus presented to the hospital with encephalopathy and necrotic ulcerating wounds with black eschar. •Numerous superficial wounds were located throughout the body including bilateral breasts, flank, legs, groin and toes. No subcutaneous nodules. •Wounds were not painful initially though progressed to severe debilitating tenderness. •Wound care consulted, no evidence of infectious process. •Given the appearance of the wounds and patient’s history of ESRD, calciphylaxis was suspected. Key Takeaways: •Calciphylaxis may mimic polyarteritis nodosa, gold standard diagnosis is based on biopsy. •While biopsy may cause risk of worsening calciphylaxis, this risk may be warranted in patients with severe ulcerating disease. •Anchoring bias is important to remember in the age of the electronic medical record and copy forward features. •Patients with skin of color have increased risk for misdiagnosis, delay in diagnosis, and treatment.
Specialty/Research Institute
Graduate Medical Education
