A 59-year-old man with end-stage renal disease and haemodialysis since 2008 was admitted with painful, non-healing ulcerations on his legs. The lesions developed without known trauma 2 months before admission (figure). Pedal pulses were palpable on both sides and there were no signs of chronic venous insufficiency.
Radiography of the soft tissue revealed diffuse calcified arterioles in a mesh-like pattern (figure).
Histological examination of skin biopsy showed sclerosis and thrombosis of blood vessels (figure) and von Kossa stains were positive for calcium deposits (figure), confirming the diagnosis of calciphylaxis.
Calciphylaxis is a syndrome of systemic medial calcification of the arteries leading to tissue necrosis. Skin biopsy and radiographic features are helpful in the diagnosis; but negative results do not necessarily exclude the diagnosis.
Although the pathogenesis remains unclear, several comorbid conditions are known to increase its development. Associated risk factors in our patient were: end-stage renal disease, secondary hyperparathyroidism, and oral anticoagulation with phenprocoumon.
皮肤样本组织学分析显示血管壁钙化和血管内血栓形成（附图），von Kossa染色中钙沉积物呈阳性（附图）， 因此确诊为钙化防御。
Recent reports indicate that low parathyroid hormone levels in association with adynamic bone diseases can also be associated with calciphylaxis.
Unfortunately, there is still no standardised treatment for calciphylaxis. Based on previous reports, phenprocoumon was withdrawn in our patient and he was treated with cinacalcet, daily haemodialysis, sodium thiosulfate, and bisphosphonate. After 4 weeks, skin condition improved and the patient was discharged home.