Navigating Calciphylaxis in End-Stage Renal Disease: A Case Report Highlighting the Complexities of Pain Control and the Need for Greater Clinical Vigilance

We present this case to increase awareness of calciphylaxis to promote early diagnosis and, therefore, improved clinical outcomes. Calciphylaxis is a rare, life-threatening complication of end-stage renal disease (ESRD) characterised by vascular calcification, thrombosis, and skin necrosis. We describe a 48-year-old female on long-term haemodialysis with obesity and prior warfarin use who developed painful abdominal plaques progressing to necrotic ulcers over six weeks. A skin biopsy performed at seven weeks confirmed focal calciphylaxis. Management involved intensified haemodialysis, intravenous sodium thiosulfate (12.5 g five times a week), and switching from warfarin to apixaban (2.5 mg twice daily). Despite specialist input and multimodal analgesia with opioids and adjuvant agents, pain control remained extremely challenging and significantly impacted quality of life. The case highlights the need for early recognition, prompt multidisciplinary management, and greater awareness among healthcare professionals of the severe pain burden and high morbidity associated with calciphylaxis to facilitate timely diagnosis and improve patient outcomes.