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New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report

BACKGROUND : Calciphylaxis is a rare life-threatening condition that is characterized by calcification of small blood vessels and soft tissues. This condition is classically described in uraemic patients with end-stage renal failure who are on dialysis or had previous renal transplant. It has also b...

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Autores principales: Diasty, Mohammad El, Cuenca, Jose
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955961/
https://www.ncbi.nlm.nih.gov/pubmed/33748662
http://dx.doi.org/10.1093/ehjcr/ytab060
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author Diasty, Mohammad El
Cuenca, Jose
author_facet Diasty, Mohammad El
Cuenca, Jose
author_sort Diasty, Mohammad El
collection PubMed
description BACKGROUND : Calciphylaxis is a rare life-threatening condition that is characterized by calcification of small blood vessels and soft tissues. This condition is classically described in uraemic patients with end-stage renal failure who are on dialysis or had previous renal transplant. It has also been reported in non-uraemic patients and those who are on warfarin therapy. It is typically associated with high calcium/phosphorus product. Patients classically present with painful skin lesion that evolve into painful ulcers. There are multiple risk factors that were reported to trigger or worsen calciphylaxis. Treatment is a multidisciplinary approach that involves elimination of risk factors, wound management, pain control, and optimization of calcium/phosphorus metabolism. Reported mortality rates are very high especially in the uraemic group. CASE SUMMARY : Here we present a case of a patient, who is on chronic renal dialysis for stage renal failure, who underwent mechanical mitral valve replacement and tricuspid valve repair. In the perioperative period, she was exposed to multiple risk factors that are known to potentially trigger prophylaxis. In the early postoperative period, she developed new-onset rapidly deteriorating skin lesions and the histopathological diagnosis confirmed calciphylaxis. Her treatment plan included pain control, frequent wound care, and optimization of nutritional and metabolic status. DISCUSSION : Calciphylaxis is a very serious condition that is usually associated with poor outcome. In this case, we discuss the unusual presentation of this condition with particular emphasis on the multiple perioperative risk factors that can potentially trigger the onset of calciphylaxis in postoperative cardiac patients. We also discuss the epidemiology, pathogenesis, diagnosis, histopathological findings, and different lines of treatment of this serious condition and the potential preventative strategies.
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spelling pubmed-79559612021-03-18 New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report Diasty, Mohammad El Cuenca, Jose Eur Heart J Case Rep Case Report BACKGROUND : Calciphylaxis is a rare life-threatening condition that is characterized by calcification of small blood vessels and soft tissues. This condition is classically described in uraemic patients with end-stage renal failure who are on dialysis or had previous renal transplant. It has also been reported in non-uraemic patients and those who are on warfarin therapy. It is typically associated with high calcium/phosphorus product. Patients classically present with painful skin lesion that evolve into painful ulcers. There are multiple risk factors that were reported to trigger or worsen calciphylaxis. Treatment is a multidisciplinary approach that involves elimination of risk factors, wound management, pain control, and optimization of calcium/phosphorus metabolism. Reported mortality rates are very high especially in the uraemic group. CASE SUMMARY : Here we present a case of a patient, who is on chronic renal dialysis for stage renal failure, who underwent mechanical mitral valve replacement and tricuspid valve repair. In the perioperative period, she was exposed to multiple risk factors that are known to potentially trigger prophylaxis. In the early postoperative period, she developed new-onset rapidly deteriorating skin lesions and the histopathological diagnosis confirmed calciphylaxis. Her treatment plan included pain control, frequent wound care, and optimization of nutritional and metabolic status. DISCUSSION : Calciphylaxis is a very serious condition that is usually associated with poor outcome. In this case, we discuss the unusual presentation of this condition with particular emphasis on the multiple perioperative risk factors that can potentially trigger the onset of calciphylaxis in postoperative cardiac patients. We also discuss the epidemiology, pathogenesis, diagnosis, histopathological findings, and different lines of treatment of this serious condition and the potential preventative strategies. Oxford University Press 2021-03-14 /pmc/articles/PMC7955961/ /pubmed/33748662 http://dx.doi.org/10.1093/ehjcr/ytab060 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Diasty, Mohammad El
Cuenca, Jose
New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title_full New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title_fullStr New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title_full_unstemmed New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title_short New-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
title_sort new-onset acute rapidly deteriorating case of calciphylaxis after open heart surgery: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955961/
https://www.ncbi.nlm.nih.gov/pubmed/33748662
http://dx.doi.org/10.1093/ehjcr/ytab060
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