Therapeutic Apheresis Treatment in a Patient with Calciphylaxis Secondary to Lupus Nephropathy on Dialysis – A Case Report

Calciphylaxis is a rare, life-threatening complication in dialysis patients, characterized by necrotic skin lesions and often linked to mineral metabolism disorders and proinflammatory states. We report a 42-year-old female with lupus nephritis on long-term hemodialysis (HD) who developed calciphylaxis after kidney transplantation complicated by acute rejection, vascular thrombosis, and surgical infection. She presented with necrotic skin ulcers, elevated inflammatory markers (ESR 96 mm/h, CRP up to 10 mg/dL), and a heterozygous MTHFR C677T mutation. Eight double-filtration plasmapheresis (DFPP) sessions over 3 months using an EC-50W filter achieved CRP (−49%) and fibrinogen (−69%) reduction, with lesion improvement. Post-session leukocyte rebound (+205%) suggested microcirculatory recovery. At treatment completion, her condition stabilized without further flare-ups. DFPP may be a valuable option for refractory calciphylaxis with persistent inflammation.