An Unusual Ulcer

This clinical case describes a 78-year-old female patient who underwent total thyroidectomy and parathyroidectomy due to thyroid cancer; surgery was followed by radioiodine therapy. The patient was treated with 20 µg of teriparatide once a day for 7 years and consistently showed above normal blood calcium levels. In addition, following the operation, the patient began taking 50 000 units of vitamin D orally every month and 1 g of calcium per os a day. A painful eschar had appeared on the front of her left leg 3 months before; it had developed into a deep, painful ulcer. The patient did not present arterial or venous diseases. Arterial hypertension was effectively managed with 5 mg of ramipril per day, renal function was normal, and the patient was not suffering from diabetes. A computed tomography scan gave evidence of extensive dermo-hypodermitis calcification in the ulcer area. A biopsy was performed and the histological examination revealed calciphylaxis. The patient was treated by suspending teriparat...