PMC9200596_01
(a) Necrotic tissues of the thighs; (b) necrotic tissues; (c) abdomen ulcers; (d) healed necrotic lesions with scars.
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A 45-year-old obese female on hemodialysis presented to the emergency department with extremely painful nodules of the lower abdomen area and necrotic lesions at the buttocks and inner surface of the thighs (Figures 1(a)-1(c)). Nowadays, she receives hemodialysis treatment with no relapses in terms of calciphylaxis (Figures 1(d) and 3(b)).
Skin biopsy.
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A definitive diagnosis of calciphylaxis was made by a skin biopsy (Figure 2), which revealed medial calcification of dermal arterioles or small arteries and fibrointimal hyperplasia, microthrombi, and vascular narrowing or occlusion, often with evidence of necrosis.
(a) Bone scintigraphy with technetium 99 m before therapy; (b) bone scintigraphy with technetium 99 m after therapy.
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A nuclear bone scan (Figure 3(a)) using scintigraphy with technetium 99 m revealed increased radiotracer uptake in the soft tissue of the thighs, homogenously and bilaterally, as well as in all areas of the skin lesions.