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• W2891340618 abstract "Question: A 65-year-old man with end-stage renal disease presented to the emergency department complaining of painful skin ulcers on his upper and lower extremities. The patient had been receiving peritoneal dialysis for the last 2 years, and he said that skin lesions developed 3 months prior. On further questioning, the patient described significant weight loss and 3 months of dysphagia to solids and liquids. On examination, the patient was cachectic and ill appearing with distal necrotic lesions of his upper and lower extremities with overlying eschars. His admission laboratory tests were significant for calcium of 6.8 mg/dL, phosphate of 12 mg/dL with a calcium-phosphorus product of 81.6 mg2/dL,2 and alkaline phosphatase of 326 μ/L. Esophagogastroduodenoscopy showed significant esophagitis with ulcerations throughout the length of the esophagus (Figure A, B). Biopsies taken during the esophagogastroduodenoscopy demonstrated prominent parakeratosis of the esophageal mucosa with calcium deposits in the subintimal layer (Figure C). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The patient was given the diagnosis of calciphylaxis with associated esophageal calcinosis. Calciphylaxis is highly morbid disease process most commonly described in patients with end-stage renal disease. Although the pathogenesis is not well-understood, the literature demonstrates involvement of the mesentery, intestines, brain, eyes skeletal muscle, lung, and recently the esophagus.1Huber A.R. Sprung Jr., B.S. JM Findeis-Hosey J.J. Esophageal mucosal calcinosis: a rare site of gastrointestinal mucosal calcinosis.Am J Case Rep. 2018; 19: 406-409Crossref PubMed Scopus (3) Google Scholar Esophageal calcinosis is extremely rare, with only 4 previously reported cases. In those reports, patients had end-stage renal disease and concomitant calciphylaxis. These patients typically present with dysphagia and less commonly with gastrointestinal bleeding. Esophagogastroduodenoscopy windings in each case were consistent, demonstrating friable mucosa with areas of erosion and ulceration.2Garber A. Arora Z. Welch N. et al.Extraosseous calcification of the esophagus: clinicopathologic correlates of esophageal mucosal calcinosis.ACG Case Rep J. 2017; 4PubMed Google Scholar, 3Machavarapu A. Brown T.A. Nwakoby I.E. Rare case of hematemesis: calciphylaxis of the esophagus.Clin Gastroenterol Hepatol. 2018; 16: A35Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 4Nigwekar S. Kroshinsky D. Nazarian R.M. et al.Calciphylaxis: risk factors, diagnosis, and treatment.Am J Kidney Dis. 2015; 66: 133-146Abstract Full Text Full Text PDF PubMed Scopus (255) Google Scholar Calciphlyaxis remains a highly morbid disease and treatment options are limited. Our patient was converted to hemodialysis, started on sodium thiosulfate thrice weekly, and started on proton pump inhibitors. The patient reported marked improvement in symptoms of dysphagia and improved oral intake, with eventual signs of weight gain after correcting his hyperphosphatemia, which corrected his calcium-phosphorus product to 35 mg2/dL.2" @default.
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• W2891340618 date "2018-12-01" @default.
• W2891340618 modified "2023-10-14" @default.
• W2891340618 title "Dysphagia in a Patient With End-Stage Renal Disease" @default.
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• W2891340618 doi "https://doi.org/10.1053/j.gastro.2018.07.053" @default.
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