Bullous Skin Lesions as a Presentation of Calcific Uremic Arteriolopathy (Calciphylaxis) in a 52-year-old Filipino Female with Chronic Kidney Disease on Renal Replacement Therapy

Calcific uremic arteriolopathy is a rare condition characterized by arteriolar calcification of the cutaneous vessels – leading to thrombosis, infarction, and ischemia. Atypical presentations have been reported in some case reports, often eluding diagnosis and delaying interventions. This is a case of a 52-year-old Filipino female with end-stage renal disease admitted for empyema thoracis, subsequently presented with multiple tender serous bullae evolving into retiform purpura of the lower extremities. Nikolsky and Asboe-Hansen signs were negative. Serum chemistries revealed hyperphosphatemia, normocalcemia, and elevated parathyroid hormone. Radiographic examination of bilateral lower extremities showed small vessels and arterial calcification. Histopathology revealed focal subcutaneous calcification. Intravenous infusion of sodium thiosulfate and pentoxifylline was started, with clinical improvement; however, the patient expired due to complications of uremia. With bullous lesions in the setting of end-stage kidney disease, atypical presentation of calciphylaxis must be considered. Rapid recognition and treatment are keys to preventing morbidity and mortality.