PMC9869808_01
Case 2 - skin biopsy. Degenerative and ischemic changes of the skin ulcer with a florid acute vasculitis of the medium and small
vessels, as well as intraluminal calcification, suggestive of Calciphylaxis
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FIG4
A skin biopsy was then arranged as shown in Figure 4.
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Case 3 - lower limb lesion. This picture depicts the patient's necrotic skin ulceration.
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FIG5
This rapidly progressed into hyperpigmented necrotic painful plaques illustrated in Figure 5.
Case 3 - skin biopsy. Epidermonecrosis with intraepithelial bullous formation, focal fibrinoid exudates in the superficial vessels and focal calcification of the vessels deep in the subcutis suggestive of calciphylaxis.
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FIG6
With a clinical suspicion of calciphylaxis, X-rays performed on his lower limb showed vascular calcification deep to the Achilles tendon and a skin biopsy was arranged as shown in Figure 6.
PMC9869808_03
Case 5 - skin biopsy. Ulcerative necrosis of the epidermis and upper dermis with fibrinoid exudates within the vessels and a heavy inflammatory infiltrate in the mid to deep dermis with calcified material within the moderate size vessel consistent with calciphylaxis.
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FIG7
A skin biopsy was done as shown in Figure 7.
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Case 6 - skin lesion. This picture demonstrates a necrotic skin ulceration with erythema and surrounding hyperpigmentation.
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FIG8
When reviewed in the clinics, a history elicited that one month prior to her commencement of HD, she had intensely painful necrotic ulcers which were rapidly progressing (Figure 8).
Case 6 - skin biopsy. Extensive fat necrosis with histocytes and scattered neutrophils within the dermis and small and medium sized vessels containing calcium deposits, but fibrin thrombi were not easily identified
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FIG9
Skin biopsy was done as shown in Figure 9.
Case 6 Healing Skin lesions. When compared to figure 8, the patient's skin ulceration has healing with likely post-inflammatory hyperpigmentation.
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FIG10
During this time the patient was still receiving sodium thiosulphate and her skin lesions had healed significantly with resolution to her intense pain (Figure 10).
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Case 7 skin lesion. This picture demonstrates the patient with lower limb necrotic ulcerations and plaques from mid to lower calf and distal desquamation of the skin.
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FIG11
Her past history revealed a blister three months prior to presentation in her right lower limb which then progressed and extended proximally and to the left lower limb to necrotic ulcers (Figure 11) that were painful and had a foul odor and discharge.
Case 7 - X-ray of lower limbs. Both lower limb X-rays demonstrate calcification of the medium and small vessels as well as the subcutaneous tissue, especially in the right lower limb
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FIG12
X-rays were arranged for suspected calciphylaxis (Figure 12) and along with a skin biopsy (Figure 13).
Case 7 - skin biopsy. Ulceration of the epidermis with severe acute inflammation and necrosis with marked calcification and thrombi within the small and intermediate vessels of the subcutaneous tissue in keeping with Calciphylaxis
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FIG13
X-rays were arranged for suspected calciphylaxis (Figure 12) and along with a skin biopsy (Figure 13).
PMC9869808_06
Case 8 - lower limb skin lesions. This picture depicts necrotic ulcerations in both lower limbs with the left lower limb having similar ulcerations in the proximal leg.
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FIG14
She presented to the nephrology team for rapidly worsening and painful leg ulcerations (Figure 14).
Case 8 - X-ray of lower limbs. Evidence of bilateral subcutaneous ankle edema with lower limb vessel calcification and soft tissue calcification suggesting calciphylaxis.
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FIG15
X-rays of her lower limbs were done (Figure 15), and a skin biopsy was subsequently performed (Figure 16). 