TY - JOUR
T1 - A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome
AU - Gioviale, Maria Concetta
AU - Buscemi, Giuseppe
AU - Cacciabaudo, Francesco
AU - Buscemi, Salvatore
AU - Tripodo, Claudio
AU - Palumbo, Vincenzo Davide
AU - Damiano, Giuseppe
AU - Lo Monte, Attilio Ignazio
AU - Sammartano, Antonino
AU - Damiano, Giuseppe
AU - Bellavia, Maurizio
AU - Spinelli, Gabriele
AU - Cacciabaudo, Francesco
AU - De Luca, Salvatore
AU - Di Ganci, Simona
AU - Gioviale, Maria Concetta
AU - Tripodo, Claudio
AU - Maione, Carolina
AU - Lo Monte, Attilio Ignazio
AU - Palumbo, Vincenzo Davide
AU - Buscemi, Giuseppe
AU - Sammartano, Antonino
AU - Buscemi, Salvatore
AU - Spinelli, Gabriele
AU - Bellavia, Maurizio
AU - Di Ganci, Simona
PY - 2012
Y1 - 2012
N2 - Background. Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results. A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. Conclusions. The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathyroidectomy can be considered as the only possible treatment.
AB - Background. Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results. A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the onset of haemolytic uremic syndrome, underwent a kidney transplant in April 2008. After transplantation there was a recurrence of the haemolytic uremic syndrome, with temporary worsening of the graft. Six months later there was a definite loss of graft and return to dialysis treatment. On April 2010 a severe systemic calciphylaxis related to secondary hyperparathyroidism was diagnosed. The patient underwent parathyroidectomy but, because of the unimproved clinical picture, treatment with sodium thiosulphate was initiated. There was only improvement in cutaneous lesions. The worsening general clinical condition of the patient caused death due to general septic complications. Conclusions. The coexistence of haemolytic uremic syndrome and secondary hyperpathyroidism makes the prognosis poor and, in this case, therapy, which counteracts calcium crystals precipitation, has no effect. Preventive parathyroidectomy can be considered as the only possible treatment.
UR - http://hdl.handle.net/10447/97453
M3 - Article
VL - 156
SP - 262
EP - 265
JO - Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
JF - Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
SN - 1213-8118
ER -