Calciphylaxis in a Renal Allograft Recipient - An Uncommon Entity, Need for Vigilance: A Case Report

Calcific uremic arteriolopathy (CUA) is characterized by small vessel medial calcification, panniculitis and dermal necrosis producing exquisitely painful and difficult to heal wounds. It is seen primarily in patients with end-stage renal disease (ESRD). It is infrequently reported in post-transplant patients. In this report, we describe a case of CUA in a 46-year-old gentleman suffering from ESRD due to diabetes. He had undergone renal transplantation two years back and had subsequently developed chronic allograft nephropathy. The patient was on conservative management. He presented with a painful, non-healing skin ulcer on right lower limb. His biochemical markers were suggestive of altered calcium-phosphorous status and secondary hyperparathyroidism. A skin biopsy from the ulcer was consistent with calciphylaxis. He was treated with intensified hemodialysis, antimicrobials, meticulous wound care with subsequent skin grafting which however, proved unsuccessful. A high index of suspicion needs to be exercised while dealing with non-healing ulcers in chronic renal failure including post-renal transplant patients.