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Calciphylaxis in a Peritoneal Dialysis Patient

A 47-year-old Caucasian male with a past medical history of ESRD secondary to diabetic nephropathy on peritoneal dialysis for eight years, Diabetes Type I, untreated hepatitis C, hypertension, and melanoma presented to the hospital with a chief complaint of skin discoloration and painful ulceration of his upper and lower extremities. On admission, his blood pressure was 117/50, heart rate 97, temperature 36.9. On physical examination well demarcated black eschar and necrosis was seen on all fingertips in addition to open lesions on toes (Figure 1,2) with palmar pallor and reticular erythematous patches. Additionally, there was one welldemarcated, clean ulceration on the right lower leg. He reported decreased sensation at the site of lesions. His upper and lower extremities were cool to palpation. His left dorsalis pedis pulse was diminished and non-palpable while the right dorsalis pedis pulse was faintly palpable and intact. Cardiac exam revealed regular rhythm and no murmurs. Pulmonary exam revealed breaths sounds that were clear to auscultation bilaterally. Laboratory studies at admission are demonstrated in (Figure 1,2) (Table 1).