Beyond the Skin: Unusual Gynecologic Involvement in Calciphylaxis

Introduction: A 53 year old female with a history of end stage renal disease, maintained on incenter hemodialysis, and recent diagnosis of calciphylaxis presented to the Emergency Department with generalized weakness and failure to thrive. Of note, calciphylaxis was previously diagnosed through tissue biopsy and clinical examination and she had been maintained on IV sodium thiosulfate with dialysis for about 1 month. She was admitted for further evaluation. Case Description: A CT scan of the abdomen and pelvis revealed "extensive uterine calcifications," along with gas and fluid in the cervix and vagina. Additionally, vaginal ulcerations had been present for two weeks prior to admission. Gynecology was consulted and performed a thorough examination as well as multiple biopsies of the cervix, vagina, endocervix, and vulva in the operating room under anesthesia. Excisional biopsies of the cervix and vagina demonstrated "predominantly necrotic tissue with fibrin deposition and focal calcification." Discussion: These imaging and biopsy findings raised concern regarding possible uterine, cervical, and vaginal calciphylaxis involvement, a phenomenon not previously described in the literature. The patient was continued on interventions for calciphylaxis management, including IV sodium thiosulfate, wound care, infection prevention and management, pain control, aggressive dialysis and fluid management, and aggressive management of bone mineral metabolism laboratory values. She was not a candidate for hyperbaric oxygen therpay and thus, this was not offered. Our case highlights the importance of recognizing calciphylaxis in atypical locations to facilitate timely diagnosis and early intervention.CT image identifying uterine calcifications.