Ina Kacso 1, Simona Racasan 2, Daniela Anghel 3, Claudia Macarie 4, Raluca Moldovan 3, Mirela Gherman Caprioara 1
1 Department of Nephrology, UMF Iuliu Haţieganu Cluj-Napoca
2 Nefromed Dialysis Center Cluj
3 Nefromed Dialysis Center Alba
4 Laboratory of Parenteral Solution, Faculty of Pharmacy, UMF Iuliu Haţieganu Cluj-Napoca
Abstract
Calciphylaxis is a life-threatening complication of hemodialysis involving calcium deposition in media of hypodermic arteries and skin necrosis. With current unsatisfactory treatment, the calcium chelator and antioxidant sodium thiosulphate emerges as a possible new therapy. We report the case of a dialysis patient with parathyroidectomy for secondary hyperparathyroidism complicated by severe hypoparathyroidism and hypocalcemia, requiring sustained Ca and vitamin D treatment. Within a year, typical calciphylaxis developed on the breasts, associated with extensive calcifi cation of medium-sized arteries on mammography. Cessation of calcium load and aggressive wound care led to no improvement. Sodium thiosulphate 25g thrice weekly for 2 months resulted in dramatic healing. Besides unusual location on the breasts, onset of lesions in the setting of an adynamic bone is noteworthy and probably favored by calcium load. Th is is, to our knowledge, the fi rst use of sodium thiosulphate in calciphylaxis associated to low bone turnover, a valuable therapeutic asset since unlike in hyperparathyroidism, other treatment options lack. Also this is the fi rst use of sodium thiosulphate for treatment of calciphylaxis in Romania, the drug being prepared in our University.