End-Stage Renal Disease and Early-Onset Calciphylaxis: A Case Report

We discuss the presentation of Mr. B, a 51-year-old African American male, diagnosed with End-Stage Renal Disease (ESRD) initiated on hemodialysis 6 months prior to presentation. After starting dialysis, the patient developed a bulla measuring approximately 8 cm x 10 cm x 2 cm, which rapidly progressed into necrotic ulcerations of the lower extremities. Work-up of the ulcerations were consistent with severe calciphylaxis. He developed these lesions just 6 months into his end-stage renal disease diagnosis. Unique to this case is the rapidity of onset, severity and extent of lesions and positive response to sodium thiosulfate. Calciphylaxis as an entity is not well understood, and there is limited evidence behind current treatments.