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Abstract
Introduction Calciphylaxis is a life-threatening disease due to progressive subcutaneous and dermal small vessel calcification resulting in thrombosis. Acral calciphylaxis is a rare subtype causing digital ischemia. There are no standardized criteria for its diagnosis, and distinguishing from peripheral vascular disease (PVD) is difficult. This study aimed to capture clinical characteristics and mortality outcomes for a series of patients with lesions suspicious for acral calciphylaxis. Methods An inpatient dermatology consult database for 2 major hospitals was screened for potential cases. Those with other causes aside from calciphylaxis vs PVD were excluded, leaving a final sample of 22 patients. Retrospective chart review was conducted, and mortality outcomes were determined. Results Mean age was 55.7 years and 65.2% of patients were male. 69.6% were White-Hispanic, and 30.4% were Black. The median number of lesions was 3. In 52.2% of all patients, vascular surgery could not exclude PVD as the etiology of ≥1of the patient’s ischemic lesions, including 6/12 with steal syndrome due to the arterio-venous fistula of the ipsilateral extremity. 21.7% of 23 patients had subsequent amputations of their affected extremity. 34.8% died within 12 months of admission. Of the 9 who expired at time of analysis, median survival was 75.5 days. Discussion Most patients presenting with acral lesions had underlying ESRD and PVD. A large proportion of acral lesions may be due to PVD rather than acral calciphylaxis. High morbidity and mortality necessitate dermatology and vascular surgery collaboration to further characterize the patterns of clinical presentation and standardize diagnostic criteria.