Calciphylaxis Induced Ulcerations . John M. Lavelle, 1 DO; Paul Liguori MD 2

1. Calciphylaxis Induced Ulcerations. John M. Lavelle,1 DO; Paul Liguori MD 2 1. Boston University Medical Center, Rehabilitation Department 2. Whittier Rehabilitation Hospital, Physical Medicine and Rehabilitation Case Diagnosis: Calciphylaxis Induced Ulcerations Discussion: Calciphylaxis is a syndrome of vascular calcification and skin necrosis. The incidence of CPX is rare and represents only approximately 1% of patients with ESRD. Disorders that coincide with calciphylaxis include chronic renal failure, obesity, diabetes mellitus, hypercalcemia, hyperphosphatemia, an elevated calcium-phosphate product, and secondary hyperparathyroidism. The pathogenesis consistently involves renal failure–induced abnormalities in calcium homeostasis. The initial clinical presentation of CPX is typically skin lesions which appear suddenly over the abdomen, thighs and buttocks as painful, indurated nodules. These can progress to necrotic, non-healing ulcerations. Our patient’s wounds had previously been treated with standard wound care procedures and were not healing. The application of non contact, low frequency ultrasound promoted wound healing and development of granulation tissue by drawing blood flow into the wound beds and it provides gentle debridement. In addition, the use of topical medical grade honey provides antimicrobial treatment further promoting an environment conducive to healing and aids in autolytic debridement. Case Description: We present a case of a 48-year-old male with multiple full thickness skin ulcers secondary to calciphylaxis (CPX).The patient had a history significant for End Stage Renal Disease (ESRD) on hemodialysis, right nephrectomy, hyperphosphatemia, hypercalcemia, morbid obesity, calciphylaxis (CPX) and intractable pain secondary to multiple necrotic skin ulcerations. The wounds were located on his right and left lower abdomen, right medial thigh and the dorsum of his left foot. These wounds were present for 15 months and nonhealing. The patient experienced 8/10 constant sharp, burning pain in these areas. The wounds were previously treated with frequent manual debridement, sulfadiazine and dry clean dressings (DCD). The patient was transferred to acute inpatient rehabilitation for management of his wounds and intensive rehabilitation therapies. His wounds upon presentation were full thickness wounds with eschar formation, slough tissue and moderate to heavy drainage. Venous mapping and ankle brachial index were not tolerated secondary to patient discomfort. Treatment with topical medical grade honey and DCD, changed daily, along with non contact, low frequency ultrasound three days per week was initiated. After 4 weeks of treatment, the wounds had no further eschar or slough tissue, decreased in size, and began developing granulation tissue. Conclusions: The overall mortality rate of patients with CPX is approximately 60%. We propose that early treatment to prevent ulcer exacerbation may reduce the mortality and morbidity rate. Also, with proper wound healing patients will be able to improve function and quality of life. Abdominal wound (descending order): Day 1, Week 2, Week 4