Nyoman Suryawati
Departemen Dermatologi And Venereologi, Fakultas Kedokteran, Universitas Udayana-RSUP Sanglah Denpasar, Bali, Indonesia

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Journal : Bali Dermatology Venereology and Aesthetic Journal

Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient Nyoman Suryawati; Herman Saputra
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 1 No. 1 (June 2018)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/vcjd9e41

Abstract

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 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.
Co-Authors Aditya Permana Aditya Permana Anang Endaryanto Andrew Wicaksono Aurelia Stephanie Bagus Bagus Bharata, Putu Evindya Vipascitadewi Nandanaya Christiana Paramita Cita Rosita Sigit Prakoeswa Darmaputra, I Gusti Nyoman Djuanda, Kevin Jonathan Duarsa, Putu Laksmi Anggari Putri Elis Indira, I Gusti Ayu Agung Evy Ervianti Gede Mahadika Pradipta Atmaja Gunawan, Regina Hasri Dewi Herman Saputra Herman Saputra Herman Saputra I Gde Nengah Adhilaksman I Gde Nengah Adhilaksman I Gusti Ayu Agung Dwi Karmila I Gusti Ayu Agung Elis Indira I Gusti Ayu Agung Praharsini I Gusti Ayu Agung Praharsisni I Gusti Nyoman Darmaputra I. G. A. A. Elis Indira Ida Ayu Uttari Priyadarshini IGAA Ellis Indira IGAA Praharsini Indira, I Gusti Ayu Agung Elis Indira, IGAA Ellis Jason Jonathan Jihan Prani Wibowo Juliari, Gusti Ayu Made Juliyanti Juliyanti - Juliyanti -, Juliyanti Ketut Kwartantaya Winaya Khathreen, Corry Laksmi, I Gusti Ayu Agung Mini Linda Astari, Linda Luh Gede Melia Puspita Sari Luh Made Mas Rusyati Made Martina Windari Made Swastika Adiguna Made Wardhana Mohana Naravenah Ni Kadek Yunita Arsita Dewi Ni Luh Putu Ratih Vibriyanti Karna Ni Made Dwi Puspawati Ni Putu Melda Dharmahayu Nyoman Upadana Nyoman Yoga Maya Pramita Paramahamsa, Shirdi Paramita, Christiana Praharsini, IGAA Pramita, I Gusti Ayu Sattwika Prima Saraswati Sanjiwani Sudarsa Primasari, Putu Yunita Putu Yonika Budiarisma Ricky Fernando Maharis Sanjiwani, Saraswati Prima Saraswati Prima Sanjiwani Saraswati Sudarsa, Prima Sanjiwani Sutiawan, Indry Salonika Wicaksono, Rafael Lilik Winaya, Ketut Kwartantaya