Fatal Masquerade: A Case of Calciphylaxis Concealed as Cellulitis

Abstract

Skin inflammation that progresses to circulatory shock is most often attributed to infection as the first hypothesis. Fluids, antimicrobial drugs, and surgical debridement are sometimes necessary. However, non-infectious causes should be considered in a patient undergoing dialysis. Differentiating between cellulitis and calciphylaxis or calcific uremic arteriolopathy (CUA) is challenging; however, the mortality rate associated with CUA is generally high. We report the case of a woman with end-stage chronic kidney disease undergoing dialysis, who complained of lower abdominal pain. The patient presented with subcutaneous infiltration and painful erythematous skin lesions in the hypogastric region. Initially, erysipelas was suspected, and antibiotic treatment was initiated. Extensive surgical debridement of the necrotic tissue was urgently performed. Histopathological examination revealed calcifications in the wall of small vessels. The patient’s condition worsened within 24 h to refractory shock, ultimately leading to death from circulatory shock.