Calcific uraemic arteriolopathy

A 52-year-old man with end-stage renal disease (ESRD) undergoing haemodialysis presented with systemic non-healing and painful skin ulceration (figure 1A,B). Two years previously, he was diagnosed with giant cell arteritis manifesting as gradual vision loss and headache, and subsequently treated with glucocorticoids. Although skin biopsy of ulcerative lesions revealed no evidence of vasculitis, we suspected cutaneous vasculitis and administered high-dose glucocorticoids. Against our expectations, the ulcers worsened. During reassessment, laboratory tests demonstrated hyperphosphataemia (2.3 mmol/L; normal, 0.80–1.45) and elevated serum parathyroid hormone levels. CT revealed a generalised vascular calcification. The final diagnosis was calcific uraemic arteriolopathy (CUA). There were no other organ involvements of CUA including the lungs, skeletal muscles, pancreas, brain, eyes or digestive tract except skin. Despite multi-interventional therapy, including sodium thiosulfate and cinacalcet, the ulcers progressed. Six months after admission, he died due to sepsis. Figure 1 (A) Violaceous, black, leathery, eschar-like lesions with surrounding erythema in the trunk, and (B) the lesion with ulceration in …