Paradoxical effects of parathyroidectomy and sodium thiosulfate in a hemodialysis patient with calciphylaxis: a case report of persistent metastatic calcification

Calcific uraemic arteriolopathy (CUA) is a rare and life-threatening condition characterized by vascular calcification, commonly observed in patients with end-stage kidney disease (ESKD). CUA is associated with a high 1-year mortality rate, ranging from 45 to 80%. Despite existing therapeutic options, managing CUA remains challenging with limited outcomes. This case report discusses a patient with ESKD undergoing long-term hemodialysis, who developed progressive CUA despite undergoing parathyroidectomy (PTX). Although sodium thiosulfate (STS) treatment promoted significant healing of skin ulcers, it had limited effects on tumoral calcinosis. This paradoxical clinical outcome highlights the complexity of managing CUA and underscores the need for a multimodal intervention strategy.