Logo CIN CIN '2007 - 4o CONGRESSO DE NEFROLOGIA NA INTERNET

Homepage

Boa vinda

Comités

Programa

Participaçao

Patrocinadores

Pt Es En

The use of sodium thiosulfate in cutaneous calciphylaxis: a novel treatment

Dra Paula Enz, Dr Carlos Musso

Dermatology Division - Hospital Italiano de Buenos Aires

Abstract

Summary: Calciphylaxis is an infrequent but severe disease found in chronic dialysis patients. Its clinical pattern consists of tissue ischemia with itchy and painful subcutaneous nodules and plaques, most often located on the abdomen, buttocks, thighs and /or legs. These injuries evolve to extensive superficial necrosis of the skin overlying the panniculitis, with ulceration, overinfection and sometimes sepsis. Current treatments used to counteract this pathology are not entirely effective. A new treatment reported for calciphylaxis, is the use of intravenous sodium thiosulfate (TS). This inorganic salt is already used in the treatment of intoxication caused by cyanide, in patients with calcic nephrolithiasis and tumoral calcinosis, with very good and safe results. Since there is not an effective treatment for this pathology and its mortality is very high, we report a case of calciphylaxis that was cured using intravenous sodium treatment. A 57 years-old woman suffering diabetes mellitus type II , obesity and end- stage renal disease on chronic haemodialysis treatment since 5 years ago. She developed hyperphosphatemia and hypercalcemia with secondary hyperparathiroidism . The patient developed a subcutaneous purple, not ulcerous and painful nodule in the left inguinal region. A subtotal parathyroidectomy was performed, but a short time after this, other hard plaques and nodules appeared in the subcutis with a stony sensation, from few cm. to 20 cm. in the abdomen, thighs, groins and legs, without affection of the underlying muscles. The violaceous aspect of the skin over the nodules in the abdomen then turned into very painful big, bleeding and necrotizing ulcers. TS has recently been proposed as an effective and safe new treatment for calciphylasis, so this therapeutic alternative was offered to the patient and accepted. We began the treatment with intravenous thiosulfate of sodium, 3 times per week. After 3 months of initiating the infusions, the lesions began to improve and concomintantly the original stony subcutaneous plaques became a group of broken pieces with a granular texture and they melted progressively until the ulcers healed and the texture of the subcutaneous tissue recoverd to the normality, in a year of treatment. To avoit ulcer overinfection we added local treatment with gentamicin plus acetamidohexanoic acid. Conclusion: Given the high mortality of calciphylaxis, the lack of an effective treatment, it seems that intravenous sodium thiosulphate could be a good therapeutical option for this condition.

Full text

Comments: