Non-healing painful ulcers in a patient with chronic kidney disease and role of sodium thiosulfate: a case report

INTRODUCTION: Calciphylaxis is a rare but dreadful complication of chronic kidney disease. It is characterized by nodular subcutaneous calcification and painful tissue necrosis which often results in ulceration and secondary infection, leading to a high rate of mortality. Pathogenesis of this disease is not well understood and there are very few, poorly studied treatment options for this disease. CASE PRESENTATION: We report a case of 60 year old Caucasian female with history of long standing diabetes and chronic kidney disease stage 5 who presented with a very high calcium phosphorous product, markedly elevated intact PTH levels and X-ray changes consistent with diagnosis of calciphylaxis. Patient was initially managed by parathyroidectomy and later on was also treated with intravenous sodium thiosulfate thrice weekly with each hemodialysis session for duration of 10 weeks. CONCLUSION: Patient had rapid and dramatic relief of her symptoms of pain. Treatment with sodium thiosulfate was well tolerated without any side effects, accompanied by significant symptomatic relief but without any effect on disease progression. So the role of sodium thiosulfate in calciphylaxis is unknown and need further studies.