Extract

A 49-year-old Taiwanese woman who had diabetes mellitus, peripheral arterial disease and end-stage renal failure treated with maintenance hemodialysis for 7 years, presented to our emergency room with a 3-month history of painful skin wound that had progressed on her left calf, which multiple stony contents on the surface. Her serum calcium and phosphorus level were elevated (10.7 and 4.6 md/dl, respectively). She also had refractory hyperparathyroidism with a recent intact parathyroid hormone concentration of 1787 pg/ml. Plain X-ray revealed markedly calcification of the vessels of the lower limbs. Histological examination of a biopsy specimen obtained from her wound of left calf showed extensive calcium deposition in the necrotic dermis and subcutaneous tissue. We diagnosed metastatic. Calcinosis cutis refers to the deposition of insoluble calcium salts into the skin and subcutaneous tissue and has been well described in patients with end-stage renal disease. Metastatic calcinosis cutis is defined as the precipitation of calcium salts in skin and occurs as a result of underlying pathophysiology related to the metabolism of calcium or phosphate. Parathyroidectomy is considered the definitive surgical treatment for metastatic calcinosis cutis. In addition, surgical debridement and systemic antimicrobial therapy should be applied, as in our case.

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