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Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report
INTRODUCTION: Calciphylaxis is a rare condition including patchy dermal necrosis that mostly affects chronic hemodialysis patients. The syndrome usually heralds impending death although patients may survive following a set of measures including an adapted dialysis regimen. The present case is a uniq...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043165/ https://www.ncbi.nlm.nih.gov/pubmed/29775967 http://dx.doi.org/10.1016/j.ijscr.2018.04.035 |
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author | Verstappen, E.M.J. Maaskant-Braat, A.J.G. Scheltinga, M.R. |
author_facet | Verstappen, E.M.J. Maaskant-Braat, A.J.G. Scheltinga, M.R. |
author_sort | Verstappen, E.M.J. |
collection | PubMed |
description | INTRODUCTION: Calciphylaxis is a rare condition including patchy dermal necrosis that mostly affects chronic hemodialysis patients. The syndrome usually heralds impending death although patients may survive following a set of measures including an adapted dialysis regimen. The present case is a unique patient who recovered from an earlier episode of upper leg calciphylaxis 5 years previously but developed fatal bilateral breast necrosis. PRESENTATION OF CASE: A 69 year old Caucasian woman with a history of atrial fibrillation, hypertension, CVA, hyperparathyroidectomy for secondary hyperparathyroidism and end stage renal disease with hemodialysis recovered in 2012 from extensive symptomatic left upper leg necrosis due to calciphylaxis. In 2017, she developed painful, necrotic ulcers on both breasts, again due to calciphylaxis. She had no history of anticoagulants use but she did use prednisolone 5mg/day. She received adequate wound care, pain medication, antibiotics and dialysis frequency was increased with an addition of sodium thiosulfate. A bilateral ablation was discussed but she decided to stop all treatment following pulmonary aspiration and passed away one week later. DISCUSSION: Calciphylaxis is a rare diagnosis that should be considered in patients with renal insufficiency developing painful patches of skin necrosis. CONCLUSION: A multidisciplinary treatment approach including hyperparathyroidectomy, modified hemodialysis and wound treatment is recommended. There is limited evidence for surgical intervention. |
format | Online Article Text |
id | pubmed-6043165 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-60431652018-07-13 Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report Verstappen, E.M.J. Maaskant-Braat, A.J.G. Scheltinga, M.R. Int J Surg Case Rep Article INTRODUCTION: Calciphylaxis is a rare condition including patchy dermal necrosis that mostly affects chronic hemodialysis patients. The syndrome usually heralds impending death although patients may survive following a set of measures including an adapted dialysis regimen. The present case is a unique patient who recovered from an earlier episode of upper leg calciphylaxis 5 years previously but developed fatal bilateral breast necrosis. PRESENTATION OF CASE: A 69 year old Caucasian woman with a history of atrial fibrillation, hypertension, CVA, hyperparathyroidectomy for secondary hyperparathyroidism and end stage renal disease with hemodialysis recovered in 2012 from extensive symptomatic left upper leg necrosis due to calciphylaxis. In 2017, she developed painful, necrotic ulcers on both breasts, again due to calciphylaxis. She had no history of anticoagulants use but she did use prednisolone 5mg/day. She received adequate wound care, pain medication, antibiotics and dialysis frequency was increased with an addition of sodium thiosulfate. A bilateral ablation was discussed but she decided to stop all treatment following pulmonary aspiration and passed away one week later. DISCUSSION: Calciphylaxis is a rare diagnosis that should be considered in patients with renal insufficiency developing painful patches of skin necrosis. CONCLUSION: A multidisciplinary treatment approach including hyperparathyroidectomy, modified hemodialysis and wound treatment is recommended. There is limited evidence for surgical intervention. Elsevier 2018-05-07 /pmc/articles/PMC6043165/ /pubmed/29775967 http://dx.doi.org/10.1016/j.ijscr.2018.04.035 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Verstappen, E.M.J. Maaskant-Braat, A.J.G. Scheltinga, M.R. Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title | Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title_full | Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title_fullStr | Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title_full_unstemmed | Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title_short | Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report |
title_sort | bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: a case report |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043165/ https://www.ncbi.nlm.nih.gov/pubmed/29775967 http://dx.doi.org/10.1016/j.ijscr.2018.04.035 |
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