Calciphylaxis - Cellulitis
Calciphylaxis is increasing in incidence (5.7 per 10 000 chronic hemodialysis patients in 2011), and is most commonly associated with chronic renal failure, hemodialysis, and secondary hyperparathyroidism. There are also many cases of "nonuremic" or "nontraditional" calciphylaxis, which can occur in the setting of liver disease, diabetes, warfarin use, use of calcium-based phosphate binders, systemic corticosteroid use, solid organ malignancies, systemic lupus erythematosus, and Crohn disease. Other risk factors include female sex, obesity, Northern European descent, and hypoalbuminemia.
Notably, warfarin-associated nonuremic calciphylaxis tends to occur about 2.5 years after warfarin initiation on the lower extremities, does not have associated calcium abnormalities, and appears to have a more favorable prognosis than calciphylaxis associated with renal failure states.
Early lesions are extremely painful, violaceous retiform patches and plaques, classically on fat-bearing areas such as the thighs, buttocks, or abdomen. This is followed by necrosis, ulcers, eschar formation, and possibly gangrene. Mortality from calciphylaxis is high (60%-87%) and is largely secondary to sepsis from large, nonhealing ulcers.
Calciphylaxis may be differentiated from cellulitis based on a history of chronic renal failure and the presence of tissue necrosis and ulceration.
E83.59 – Other disorders of calcium metabolism
237900002 – Calciphylaxis
- Cellulitis – No association with chronic renal failure and does not have the presence of tissue necrosis and ulceration.
- Antiphospholipid syndrome
- Lupus profundus lesions may have calcification on x-ray.
- Dermatomyositis and CREST syndrome may have associated calcification.
- Coumadin necrosis – Indurated, necrotic areas on the breasts, thighs, and buttocks.
- The livedo pattern can occur by itself after exposure to extreme warmth from a hot-water bottle or laptop computer or from a fireplace (erythema ab igne).
- Cholesterol emboli
- Myxoma emboli (atrial myxoma)
- Pyoderma gangrenosum
- Granulomatosis with polyangiitis (formerly Wegener granulomatosis)
- Cocaine levamisole toxicity
Last Updated: 04/14/2017