Calciphylaxis in End-Stage Renal Disease: A Case of Nonhealing Ulcer and Diagnostic Challenges

Calciphylaxis is a rare, life-threatening condition characterized by calcification, fibrosis, and thrombosis of small- to medium-sized dermal vessels, leading to painful skin lesions and necrosis, primarily in patients with end-stage renal disease (ESRD). We present the case of a 76-year-old male patient with ESRD on hemodialysis who developed a nonhealing, necrotic ulcer over the posterior aspect of his right leg. Clinical features, laboratory findings, and histopathological examination confirmed the diagnosis of calciphylaxis. Management included intensification of dialysis, discontinuation of warfarin, correction of calcium-phosphate imbalance, wound care, and targeted antibiotics. Despite the multidisciplinary intervention, the patient experienced prolonged healing complicated by secondary infection. This case underscores the diagnostic and therapeutic challenges associated with calciphylaxis and highlights the need for early recognition and individualized treatment to improve patient outcomes.