Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient

Nyoman Suryawati , Herman Saputra

Nyoman Suryawati
Department of Dermatology and Venereology, Faculty of Medicine Udayana University, Sanglah General Hospital. Email:

Herman Saputra
Department of Pathologic Anatomy, Faculty of Medicine Udayana University, Sanglah General Hospital
Online First: May 11, 2018 | Cite this Article
Suryawati, N., Saputra, H. 2018. Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient. Bali Dermatology and Venereology Journal 1(1). DOI:10.15562/bdv.v1i1.3

Introduction: Lower extremity ulcers often create diagnostic challenges and influence patient morbidity and mortality. The most common causes are venous insufficiency, arterial insufficiency, and neuropathic. Ulcers associated with systemic condition often face diagnostic and therapeutic challenge. We report a necrotic lower extremity ulcer caused by calciphylaxis in a patient with chronic renal failure. Case: We reported a 48-year-old Javanese woman, complained of painful lower extremities ulcers since 1.5 months ago. The patient had a history of renal failure and hypertension, undergone routine hemodialysis since 13 years ago, and used Continuous Ambulatory Peritoneal Dialysis (CAPD) since one year ago. Dermatology status on dorsum pedis sinister as well as cruris dexter and sinister showed multiple ulcers on livid skin covered by black eschar, accompanied by tenderness. Laboratory results showed anemia (Hb 7.6), hypoalbuminemia (2.7), increased serum urea level (170.4 mg/dl), increased serum creatinine (11.23 mg/dl), increased calcium (10.4 mg/dl), high inorganic phosphorus (8.5 mg/dl) and high parathyroid hormone (2,164). BOF examination showed abdominal calcification, while radiographic examination on cruris dexter et sinister showed soft tissue calcification and osteoporosis. Histopathology result supported the presence of calciphylaxis. The patient was diagnosed with stage V chronic renal failure, hypertension, and calciphylaxis caused by secondary hyperparathyroidism. She was managed by low calcium and phosphate diet, lanthanum, paracetamol, folic acid, adalat oros, captopril and wound debridement. Conclusion: Calciphylaxis is a rare phenomenon of cutaneous necrosis associated with end-stage renal disease. Control of end-stage renal disease may be an important factor for treatment of calciphylaxis and patient with calciphylaxis usually had a poor prognosis.

Keywords: necrotic lower extremity ulcer, chronic renal failure, calciphylaxis


Panuncialman J, Falanga V. Unusual causes of cutaneous ulceration. Surg Clin North Am. 2010;90:1161–80.

Malhi HK, Didan A, Ponosh S, Kumarasinghe SP. Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer. Case Rep Dermatol. 2017;9:95–102.

Fukaya E, Margolis DJ. Approach to diagnosing lower extremity ulcers: Diagnosing lower extremity ulcers. Dermatol Ther. 2013;26:181–6.

Oh D, Eulau D, Tokugawa D, McGuire J, Kohler S. Five cases of calciphylaxis and a review of the literature. J Am Acad Dermatol 1999;40:979–87.

Jeong HS, Dominguez AR. Calciphylaxis: Controversies in Pathogenesis, Diagnosis and Treatment. Am J Med Sci. 2016;351:217–27.

Dean S. Atypical ischemic lower extremity ulcerations: a differential diagnosis. Vasc Med 2008; 13:47–54.

Llach F. The evolving clinical features of calciphylaxis. Kidney Int 2003; 85:s122-4.

Diane M, Touart M, Sau. Cutaneous deposition diseases. Part II. J Am Acad Dermatol 1998; 9:527–44.

Jeluka T. Calciphylaxis – Changing Concepts. Nephrol Rounds 2005; 6.

Graves J, Morris J, Sheps S. Martorell’s hypertensive leg ulcer: case report and concise review of the literature. J Hum Hypertens 2001;15:279–83.

Papi M, Papi C. Vasculitic Ulcers. Int J Low Extrem Wounds. 2016;15:6–16.

Wollina U. Pyoderma gangrenosum – a review. Orphanet J Rare Dis 2007; 2:19.

Marks B, Bakou J, Ibrahim. End-Stage Renal Disease and Early-Onset Calciphylaxis: A Case Report. J Clin Med Case Rep 2017;4:4.

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