(297) PENILE CALCIPHYLAXIS PRESENTING WITH TERTIARY HYPERPARATHYROIDISM: A CHALLENGING CASE REPORT

Abstract Introduction Penile calciphylaxis (PC) is an uncommon and potentially life-threatening syndrome with an estimated 6-month mortality rate. PC is characterized by the obstruction of small vessels within the subcutaneous adipose tissue and dermis of the penis. The precise etiology of calciphylaxis is not entirely understood, but it is frequently associated with conditions such as end-stage kidney disease (ESKD), chronic kidney disease (CKD), and the use of medications like warfarin. Symptoms of PC may include pain, discoloration, and the formation of non-healing ulcers on the penis. Management of PC involves controlling medical risk factors to mitigate vascular calcification, alongside interventions such as surgical debridement, penectomy, and local wound care. Objective We report a case of a patient with ESKD who presented with necrotic ulcers of his penis and was found to have tertiary hyperparathyroidism. Methods A 69-year-old male patient was referred to our institution due to a distressing necrotic lesion encompassing 60% of the glans penis over the preceding two months. His medical history includes tertiary hyperparathyroidism, diabetes, hypertension, cardiomyopathy, and ESRD (grade V). The patient underwent renal transplantation; however, two years after the transplant, he lost kidney function and returned to dialysis. Laboratory analyses revealed significantly elevated levels of parathyroid hormone (PTH) at 1350 pg/ml, calcium at 1.34 mmol/L, and vitamin D at 30 ng/ml. A pelvic CT scan revealed a pervasive pattern of calcification within the aorta, branches of the celiac axis, and penile vessels (Fig. 1 and 2). Patient was initially started on broad-spectrum antibiotics, including ciprofloxacin, azithromycin, and ceftazidime with any improvement. Cultures from the blood and gangrenous site were negative. Results Treatment with sodium thiosulfate was initiated in conjunction with daily PDE-5-inhibitors for 2 – months before complete parathyroidectomy. Pain score from the penile ulcers started to regress along with the complete reepithelization of the ulcer. At 2 – years of follow up from the initial treatment patient is still alive with any other new onset of the ulcers. Conclusions PC represents a significant life-threatening condition in patients with ESRD with a compromised overall survival as reported in the literature. The uniqueness of our study lies in the combined use of a PDE-5 inhibitor along with parathyroidectomy to overcome the nature of the disease, leading to improved patient quality of life. Nonetheless, due to severity of the disease there’s need for. Disclosure No.