Complete resolution of calciphylaxis in a renal transplant patient with Calcifediol

Presentation: A 62-year-old woman with a Living Donor Kidney transplant in 2008 complicated with chronic kidney disease III, lupus nephritis, hypothyroidism (but no history of diabetes) presented with painful, bilateral, medial calf ischaemic ulcerations (figure 1), which on punch biopsy revealed calciphylaxis (figure 2). Her weight was 66.3 kg, height 1.6 m and body mass index of 25.9 kg/m2. She was on hydroxychloroquine, mycophenolate and prednisone for lupus/transplant and levothyroxine 125 mcg daily for hypothyroidism. Her baseline intact parathyroid harmone (iPTH), calcium, phosphorus and 25-hydroxy-vitamin D was 372 pg/mL, 9.4 mg/dL, 3.8 mg/dL and 17.4 ng/mL, respectively (table 1depicting laboratories and medication changes over time). She was on calcitriol (0.75 mcg/daily), ergocalciferol (50 000 units weekly) and cinacalcet 30 mcg every other day. We started her on calcifediol 30 mg, which was later increased to 60 mg daily. Her calcitriol and ergocalciferol doses were reduced slowly, while cinacalcet remained the same. This...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Images Source Type: research