Calciphylaxis: A Case Report and Review of the Role of Sodium Thiosulphate and Other Treatment Modalities

Calciphylaxis is a rare and serious disorder almost exclusively seen in patients on dialysis or those with advanced chronic kidney disease (CKD) not on dialysis and is associated with very high mortality. We present the case of a 50-year-old male with a background of end-stage renal disease (ESRD) compliant with dialysis, parathyroid adenoma, secondary hyperparathyroidism, and high body mass index (BMI). Whilst receiving 31 doses of intravenous sodium thiosulphate (STS) over an 11-week period, the patient underwent surgical debridement of multiple painful ulcerative lesions in his lower abdomen and left thigh and then subsequently a subtotal parathyroidectomy at 70 days from admission. Afterwards, he recovered from the surgery but became septic secondary to infection of calciphylaxis ulcers, later developed hospital-acquired pneumonia, and died with palliative care input. Despite intravenous STS being the most commonly used drug in the treatment of calciphylaxis, it did not provide symptomatic relief or clinical improvement to the patient in this case. As there is no consensus on treatment duration for optimal response, this prompts future studies on the use of STS in addition to alternative treatment modalities of calciphylaxis.