Calciphylaxis mimicking inflammatory breast cancer

Calciphylaxis is a rare disorder characterized by microcalcification of small- and medium-sized blood vessels causing cutaneous and soft tissue necrosis. Patients usually present with painful, violaceous skin discoloration in a livedo reticularis pattern. We present a case of a 59-year-old woman with end-stage renal disease (ESRD) who manifested signs and symptoms of inflammatory breast cancer. The patient underwent an open biopsy and subsequent mastectomy, with final pathology results of calciphylaxis. Due to recurrent hyperparathyroidism, she underwent a re-parathyroidectomy with reimplantation. To our knowledge, this is the first reported case of calciphylaxis recurrence after subtotal parathyroidectomy. We propose that those patients with ESRD who develop breast pathology consistent with inflammation and necrosis, and have no malignancy, be evaluated for secondary hyperparathyroidism. Total parathyroidectomy with reimplantation should be performed. Mastectomy should be performed for unresolving symptoms, necrosis or infection.