Calcifying panniculitis with renal failure: A new management approach

A 60-year-old woman with chronic renal failure, hyperphosphatemia, normocalcemia and hyperparathyroidism presented with skin and subcutaneous tissue necrosis over the upper lateral aspects of both thighs which became progressively worse with subsequent ulceration over the period of 1 week. A biopsy of the affected skin and subcutaneous tissues demonstrated discrete foci of calcification compatible with the diagnosis of calcifying panniculitis. While it was possible to control the patient's hyperphosphatemia using magnesium carbonate, local ulcer care, including daily whirlpool and repeated local surgical excision, failed to stop the progression of the surrounding skin and subcutaneous tissue necrosis with subsequent ulceration. A trial of oral prednisone fora total of 10 days followed by oral cimetidine for 3 months resulted in complete healing at the incision sites without recurrence after 9 months. In this case of calcifying panniculitis the conditions for calciphylaxis were present, and a new management approach was applied.