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• W2010756806 abstract "A 61-year-old man who had had diabetes mellitus for 25 years and renal failure requiring peritoneal dialysis for 7 years initially presented with a gangrenous left foot and underwent a partial amputation. During that admission, the patient received low-dose warfarin prophylaxis. Four months later, he presented with a presumed penile infection. The infection did not resolve with antibiotic treatment, and the tip of his penis formed an eschar. He returned 1 month later with complaints of tenderness and a violet rash on the lateral aspect of both thighs. Skin biopsy findings were consistent with a diagnosis of calcific uremic arteriolopathy (CUA). Histopathologic studies showed thrombi within arterioles (white arrows) and intimal calcification (black arrow). Retrospective evaluation of specimens obtained from the original foot surgery also revealed evidence of CUA. The penile lesion was not biopsied but was likely related to the same disease process. Acral (fingers, toes, tongue, penis) distribution of lesions has been described in patients with CUA.1Jenkins MA Pirani JF Conner WT Calciphylaxis presenting as penile gangrene.Infect Urol. 2001; 14: 105-109Google Scholar Dermatologic findings may resemble vasculitis and atherosclerotic peripheral vascular disease. The defining feature of CUA is calcification of the medial layer of small vessels.2Wilmer WA Magro CM Calciphylaxis: emerging concepts in prevention, diagnosis, and treatment.Semin Dial. 2002; 15: 172-186Crossref PubMed Scopus (266) Google Scholar Although calcification is usually chronic, unknown triggers lead to acute thrombogenic microangiopathy and infarction of subcutaneous adipose tissue. Lesions begin as localized tender, broad violaceous nodular plaques. Necrosis and eschar formation may develop within days. Risk factors for CUA include elevated phosphorus levels, increased body mass index, and hypoalbuminemia.3Mazhar AR Johnson RJ Gillen D et al.Risk factors and mortality associated with calciphylaxis in end-stage renal disease.Kidney Int. 2001; 60: 324-332Crossref PubMed Scopus (286) Google Scholar Warfarin therapy has also been implicated as a cause of CUA, and animal studies have helped to define the pathophysiology. Matrix Gla protein (MGP) has been shown to inhibit vascular calcification. In mice, disruption of MGP leads to diffuse calcification of vessels and rapid death.4Howe AM Webster WS Warfarin exposure and calcification of the arterial system in the rat.Int J Exp Pathol. 2000; 81: 51-56Crossref PubMed Scopus (56) Google Scholar Warfain-induced γ-carboxylation inhibits activation of MGP and predisposes patients to vascular calcification. Therapy consists of lowering serum phosphorus, calcium, and parathyroid hormone levels.5Russell R Brookshire MA Zekonis M Moe SM Distal calcific uremic arteriolopathy in a hemodialysis patient responds to lowering of Ca x P product and aggressive wound care.Clin Nephrol. 2002; 58: 238-243Crossref PubMed Google Scholar Local wound management including débridement and antibiotics may be necessary. In some cases, hyperbaric oxygen therapy helps heal wounds." @default.
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• W2010756806 title "Calcific Uremic Arteriolopathy (Calciphylaxis)" @default.
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• W2010756806 doi "https://doi.org/10.4065/81.1.9" @default.
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