Calciphylaxis in Pre‑dialysis Chronic Kidney Disease: Case Report

Calciphylaxis is a rare life‑threatening vasculopathy resulting from calcium deposition in the arteriolar microvasculature of the deep dermis and subcutaneous adipose tissue, mainly occurring in end‑stage kidney disease (ESKD) treated with maintenance dialysis. Calciphylaxis in patients without ESKD is even rarer, which makes the diagnosis of calciphylaxis challenging in this population. In patients with any stage of kidney disease, there should be high clinical suspicion of calciphylaxis after the appearance of painful nodules, indurated plaques, dusky livedoid plaques, or nonblanching retiform purpura. We present a clinical case of a 75‑year‑old female with stable stage 5 chronic kidney disease who developed an ulcerated skin lesion on the posterior surface of the right lower limb, in whom calciphylaxis was not initially suspected because several common risk factors were not present, such as maintenance dialysis, altered calcium‑phosphate product or warfarin use. A biopsy‑proven diagnosis of calciphylaxis was made. Re‑epithelialization of the ulcerated lesions was achieved after the induction of haemodialysis, administering sodium thiosulfate in each dialysis session, wound care, and pain control through a multidisciplinary approach. Early identification and directed therapy initiation may be lifesaving in a disease that portends an ominous prognosis.