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Clinical Cases in mineral and bone metabolism

Calcific arteriolopathy beyond chronic kidney disease.
The role of hemochromatosis and vitamin K antagonists

Case report, 85 - 88
doi: 10.11138/ccmbm/2018.15.1.085
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Abstract
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Background. Calcific artheriolopathy (calciphylaxis) is an infrequent but important cause of mortality. It is observed in chronic kidney disease patients with abnormal mineral metabolism and metabolic bone disease. There are also reports of this pathology in patients with obesity and some medications. The presence of calciphylaxis and hemochromatosis in the same patient is exceptional. Indeed, we have not found any other case reported in literature.
Case description. A 69-year-old Caucasian male was admitted to hospital because of extremely high serum ferritin levels, jaundice and mottled purpuric lesion on right-leg. Six months before admission a right-leg deep vein thrombosis was diagnose and acenocoumarol treatment started. Lesion became painful and necrotic after few days. Laboratory data showed a normal renal function.
Parathyroid hormone, serum calcium and phosphate levels also within the normal range. In addition, genetic study reported a dual hemochromatosis mutation.
Treatment with sodium thiosulfate was started but the patient died two months after diagnosis.
Conclusions and relevance. Calciphylaxis is a rare but important cause of mortality. Combination of hemochromatosis plus acenocoumarol treatment may be associated with calciphylaxis. We suggest that more studies should be conducted to understand the mechanism of vascular calcification in patients on acenocoumarol treatment.

Vol. XV (No. 2) 2018 May - August

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